Provider Demographics
NPI:1851864920
Name:ALOHA FAMILY DENTISTRY HAWAII
Entity Type:Organization
Organization Name:ALOHA FAMILY DENTISTRY HAWAII
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:J
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-235-0018
Mailing Address - Street 1:45-1144 KAMEHAMEHA HWY STE 304
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-3226
Mailing Address - Country:US
Mailing Address - Phone:808-235-0018
Mailing Address - Fax:
Practice Address - Street 1:45-1144 KAMEHAMEHA HWY STE 304
Practice Address - Street 2:
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744-3226
Practice Address - Country:US
Practice Address - Phone:808-235-0018
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-10
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIDT2559OtherHAWAII STATE DENTAL LICENSE