Provider Demographics
NPI:1750742730
Name:KAUAI FAMILY DENTISTRY, INC.
Entity type:Organization
Organization Name:KAUAI FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KAIMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOO-RAHTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-823-8707
Mailing Address - Street 1:437 PAPALOA RD
Mailing Address - Street 2:
Mailing Address - City:KAPAA
Mailing Address - State:HI
Mailing Address - Zip Code:96746-1454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:437 PAPALOA RD
Practice Address - Street 2:
Practice Address - City:KAPAA
Practice Address - State:HI
Practice Address - Zip Code:96746-1454
Practice Address - Country:US
Practice Address - Phone:808-823-8707
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI25311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty