Provider Demographics
NPI:1801953542
Name:MADEISKY, JOCHEN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOCHEN
Middle Name:
Last Name:MADEISKY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 428
Mailing Address - Street 2:
Mailing Address - City:KAPAAU
Mailing Address - State:HI
Mailing Address - Zip Code:96755-0428
Mailing Address - Country:US
Mailing Address - Phone:808-889-6277
Mailing Address - Fax:808-889-0201
Practice Address - Street 1:54-3872 AKONI PULE HWY.
Practice Address - Street 2:
Practice Address - City:KAPAAU
Practice Address - State:HI
Practice Address - Zip Code:96755
Practice Address - Country:US
Practice Address - Phone:808-889-6277
Practice Address - Fax:808-889-0201
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HID10511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice