Provider Demographics
NPI:1740863927
Name:DIAMOND HEAD DENTAL CARE PCG CORP
Entity type:Organization
Organization Name:DIAMOND HEAD DENTAL CARE PCG CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-286-1714
Mailing Address - Street 1:6370 HAWAII KAI DR APT 35
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-5215
Mailing Address - Country:US
Mailing Address - Phone:808-286-1714
Mailing Address - Fax:
Practice Address - Street 1:1160 KUALA ST STE 200
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2962
Practice Address - Country:US
Practice Address - Phone:808-735-8883
Practice Address - Fax:808-732-0240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental