Healthcare Provider Details

I. General information

NPI: 1245007764
Provider Name (Legal Business Name): KENIA MARIA COOK DENTAL HYGIENIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2023
Last Update Date: 12/05/2023
Certification Date: 12/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NHC HAWAII 6905 HARRIS AVE
KAILUA HI
96734
US

IV. Provider business mailing address

PSC 558 BOX 4394
FPO AP
96375-0044
US

V. Phone/Fax

Practice location:
  • Phone: 808-257-3365
  • Fax:
Mailing address:
  • Phone: 407-719-9863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH21071
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: