Provider Demographics
NPI:1356912505
Name:EVERETT, KAEO (DMD)
Entity type:Individual
Prefix:DR
First Name:KAEO
Middle Name:
Last Name:EVERETT
Suffix:
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 1:45-031 HOLOWAI PL
Mailing Address - Street 2:
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744-2705
Mailing Address - Country:US
Mailing Address - Phone:808-398-9910
Mailing Address - Fax:
Practice Address - Street 1:500 ALA MOANA BLVD STE 7-200
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-4920
Practice Address - Country:US
Practice Address - Phone:808-523-3116
Practice Address - Fax:808-523-3121
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-2912122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist