Provider Demographics
NPI:1851663033
Name:ALA MOANA DENTAL CARE, INC.
Entity Type:Organization
Organization Name:ALA MOANA DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL/INSURANCE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:CLOUTIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-941-5555
Mailing Address - Street 1:1601 KAPIOLANI BLVD
Mailing Address - Street 2:#101
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-4704
Mailing Address - Country:US
Mailing Address - Phone:808-941-5555
Mailing Address - Fax:808-947-2333
Practice Address - Street 1:1601 KAPIOLANI BLVD
Practice Address - Street 2:#101
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4704
Practice Address - Country:US
Practice Address - Phone:808-941-5555
Practice Address - Fax:808-947-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty