Provider Demographics
NPI:1851491245
Name:URADA, KEVIN (PHD, DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:URADA
Suffix:
Gender:M
Credentials:PHD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 HAILI ST
Mailing Address - Street 2:BLDG B
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2975
Mailing Address - Country:US
Mailing Address - Phone:808-961-4071
Mailing Address - Fax:808-961-5678
Practice Address - Street 1:16-192 PILIMUA STREET
Practice Address - Street 2:
Practice Address - City:KEAAU
Practice Address - State:HI
Practice Address - Zip Code:96749-8134
Practice Address - Country:US
Practice Address - Phone:808-930-0400
Practice Address - Fax:808-930-0438
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2013-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HICSDT 55122300000X
WADE00010676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist