Provider Demographics
NPI:1871659243
Name:APALLA, ANTOLIN GALDONES JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ANTOLIN
Middle Name:GALDONES
Last Name:APALLA
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4139 HARDY ST STE D
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1357
Mailing Address - Country:US
Mailing Address - Phone:808-246-2580
Mailing Address - Fax:808-246-9461
Practice Address - Street 1:4139 HARDY ST STE D
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1357
Practice Address - Country:US
Practice Address - Phone:808-246-2580
Practice Address - Fax:808-246-9461
Is Sole Proprietor?:No
Enumeration Date:2006-12-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI18671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIC20382-2OtherHMSA-DENTAL
HI99-0351740OtherHMAA-DENTAL
HI186701OtherHDS-DENTAL
HID20382-0Medicaid