Provider Demographics
NPI:1932508389
Name:DENTAL IMPLANT ASSOCIATES, LLC
Entity Type:Organization
Organization Name:DENTAL IMPLANT ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-969-1839
Mailing Address - Street 1:784 KINOOLE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-3870
Mailing Address - Country:US
Mailing Address - Phone:808-969-1839
Mailing Address - Fax:808-969-1838
Practice Address - Street 1:784 KINOOLE ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-3870
Practice Address - Country:US
Practice Address - Phone:808-969-1839
Practice Address - Fax:808-969-1838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DENTAL IMPLANT ASSOCIATES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-08-21
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 22131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty