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General NPI Number Information
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NPI Number | 1295111615
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Entity Type | Organization
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Legal Business Name | MAUI DENTAL PROFESSIONALS LLC
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Dates
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Enumeration Date | 08/07/2015
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Last Update Date | 08/07/2015
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Provider Practice Location Address
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Address Line | 54 MAUI LANI PKWY SUITE 2020
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City | WAILUKU
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State | HI
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Zip | 96793-2467
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Country | US
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Telephone | 808-268-5175
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Fax |
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Provider Business Mailing Address
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Address Line | 54 MAUI LANI PKWY SUITE 2020
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City | WAILUKU
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State | HI
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Zip | 96793-2467
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER/OWNER
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Name | TODD GIRARD
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Credential |
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Telephone | 808-268-5175
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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 | DT2142
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License Number State | HI
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