Healthcare Provider Details

I. General information

NPI: 1518688803
Provider Name (Legal Business Name): PUKALANI DENTAL LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/06/2022
Certification Date: 09/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 KUPAOA ST STE 203
MAKAWAO HI
96768-6215
US

IV. Provider business mailing address

11 HANALE WAY
KULA HI
96790-8502
US

V. Phone/Fax

Practice location:
  • Phone: 808-572-9111
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DARYL YAMADA
Title or Position: PARTNER
Credential: DDS
Phone: 808-269-5823