Provider Demographics
NPI:1013683358
Name:MAUNA FAMILY DENTAL
Entity Type:Organization
Organization Name:MAUNA FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO- OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KHEALYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-857-8001
Mailing Address - Street 1:280 PONAHAWAI ST STE 201
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3075
Mailing Address - Country:US
Mailing Address - Phone:808-935-5488
Mailing Address - Fax:
Practice Address - Street 1:280 PONAHAWAI ST STE 201
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3075
Practice Address - Country:US
Practice Address - Phone:808-935-5488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-17
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental