Provider Demographics
NPI:1972023968
Name:WAIMANALO DENTISTS LLC
Entity Type:Organization
Organization Name:WAIMANALO DENTISTS LLC
Other - Org Name:HAWAII DENTAL CLINIC WAIMANALO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:DR
Authorized Official - First Name:NOLAN
Authorized Official - Middle Name:
Authorized Official - Last Name:KIDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-538-6522
Mailing Address - Street 1:50 S BERETANIA ST STE C117B
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2287
Mailing Address - Country:US
Mailing Address - Phone:808-538-6522
Mailing Address - Fax:
Practice Address - Street 1:41-1537 KALANIANAOLE HWY
Practice Address - Street 2:
Practice Address - City:WAIMANALO
Practice Address - State:HI
Practice Address - Zip Code:96795-1185
Practice Address - Country:US
Practice Address - Phone:808-538-6522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2017-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty