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General NPI Number Information
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NPI Number | 1083656359
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Entity Type | Organization
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Legal Business Name | HUALALAI DENTAL SERVICES
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 75-1028 HENRY ST SUITE 203
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City | KAILUA KONA
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State | HI
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Zip | 96740-1693
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Country | US
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Telephone | 808-329-4425
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Fax | 808-329-0872
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Provider Business Mailing Address
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Address Line | 555 W BENJAMIN HOLT DR BUILDING B
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City | STOCKTON
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State | CA
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Zip | 95207-3839
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Country | US
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Telephone | 309-476-4700
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Fax | 209-478-6430
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Authorized Official
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Title or Position | PC HOLDER
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Name | DR. LEIGHTON THOMAS MILLER
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Credential | DDS
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Telephone | 209-476-4700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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