Provider Demographics
NPI:1912591173
Name:GARDEN ISLAND DENTAL LLC
Entity Type:Organization
Organization Name:GARDEN ISLAND DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:GODLA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:808-245-3582
Mailing Address - Street 1:4347 RICE ST STE 202
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1335
Mailing Address - Country:US
Mailing Address - Phone:808-245-3582
Mailing Address - Fax:
Practice Address - Street 1:4347 RICE ST STE 202
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1335
Practice Address - Country:US
Practice Address - Phone:808-245-3582
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-26
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1467871780OtherNPI 1