Healthcare Provider Details

I. General information

NPI: 1134817554
Provider Name (Legal Business Name): KELLEY NICOLE HOARD DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2023
Last Update Date: 04/25/2023
Certification Date: 04/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 MAKAHIKI WAY
HONOLULU HI
96826-2896
US

IV. Provider business mailing address

4709B TRENT RIVER DR
TRENT WOODS NC
28562-7527
US

V. Phone/Fax

Practice location:
  • Phone: 808-537-8366
  • Fax: 808-664-8736
Mailing address:
  • Phone: 252-474-9070
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: