Healthcare Provider Details

I. General information

NPI: 1104087303
Provider Name (Legal Business Name): BENJAMIN KARL MEAD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16-192 PILIMUA ST.
KEA'AU HI
96749-8134
US

IV. Provider business mailing address

244 HAILI STREET BLDG B
HILO HI
96720-2975
US

V. Phone/Fax

Practice location:
  • Phone: 808-930-0400
  • Fax: 808-775-1314
Mailing address:
  • Phone: 808-961-4071
  • Fax: 808-775-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDT 2347
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: