Provider Demographics
NPI:1851943203
Name:ITA, ARIEL KEIKO MIU LIN (RDH)
Entity Type:Individual
Prefix:MS
First Name:ARIEL
Middle Name:KEIKO MIU LIN
Last Name:ITA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 KAMEHAMEHA HWY APT 4101B
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2575
Mailing Address - Country:US
Mailing Address - Phone:808-358-1614
Mailing Address - Fax:
Practice Address - Street 1:98-1005 MOANALUA RD SPC 2000
Practice Address - Street 2:
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4700
Practice Address - Country:US
Practice Address - Phone:808-489-9530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDH-1792124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist