Provider Demographics
NPI:1841644499
Name:DELATORI, KUULEI (RDH)
Entity type:Individual
Prefix:
First Name:KUULEI
Middle Name:
Last Name:DELATORI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WALLOWA
Mailing Address - State:OR
Mailing Address - Zip Code:97885-7102
Mailing Address - Country:US
Mailing Address - Phone:541-398-1676
Mailing Address - Fax:
Practice Address - Street 1:401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:JOSEPH
Practice Address - State:OR
Practice Address - Zip Code:97846-5001
Practice Address - Country:US
Practice Address - Phone:541-432-6555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-20
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH7011124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist