Provider Demographics
NPI:1013433341
Name:MILILANI DENTAL INC.
Entity Type:Organization
Organization Name:MILILANI DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADFORD
Authorized Official - Middle Name:
Authorized Official - Last Name:MATIASEVICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-366-1097
Mailing Address - Street 1:95-1249 MEHEULA PKWY STE 138
Mailing Address - Street 2:
Mailing Address - City:MILILANI
Mailing Address - State:HI
Mailing Address - Zip Code:96789-1788
Mailing Address - Country:US
Mailing Address - Phone:808-625-6223
Mailing Address - Fax:
Practice Address - Street 1:95-1249 MEHEULA PARKWAY
Practice Address - Street 2:138
Practice Address - City:MILILANI
Practice Address - State:HI
Practice Address - Zip Code:96789
Practice Address - Country:US
Practice Address - Phone:808-625-6223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-18
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI2481261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000316307OtherHMSA