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HAWAII DENTAL GROUP, INC.

Dental Providers Dentist Endodontics

Provider NPI: 1689982407

Organization Information:
Organization Name:  HAWAII DENTAL GROUP, INC.
Organization is Subpart
Authorized Official:  GARY  KONDO  CHIEF EXECUTIVE OFFICER  808-523-3103

Practice Location:
75-1028 HENRY ST SUITE 102 KAILUA KONA, HI 96740-1693 US
Tel: 808-329-0025  Fax: 808-329-4164

Business Mailing Address:
500 ALA MOANA BLVD SUITE 7-220 HONOLULU, HI 96813-4920 US
Tel: 808-523-3103  Fax: 808-523-3122

NPI Information:
NPI: 1689982407
Entity Type: Organization

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
N1223E0200XDental Providers
Dentist
Endodontics
N1223P0221XDental Providers
Dentist
N1223P0300XDental Providers
Dentist
N1223P0700XDental Providers
Dentist
N1223X0400XDental Providers
Dentist
N124Q00000XDental Providers
Dental Hygienist
N126800000XDental Providers
Dental Assistant
Y1223G0001XDental Providers
Dentist

Other Provider Identifiers:

IssuerNumberStateType



American Medical Association 2012 taxonomy code information

Code: 1223G0001X

Type:

Classification:



Definition:



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