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General NPI Number Information
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NPI Number | 1467135376
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Entity Type | Individual
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Provider Name | KRISTEN RENAE GRADY DENTAL HYGIENIST
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Gender | Female
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Dates
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Enumeration Date | 08/08/2023
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Last Update Date | 08/08/2023
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Provider Practice Location Address
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Address Line | MONTGOMERY DRIVE #339
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City | HONOLULU
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State | HI
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Zip | 96819
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Country | US
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Telephone | 808-438-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 109 YASUTAKE RD
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City | HONOLULU
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State | HI
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Zip | 96819-4811
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Country | US
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Telephone | 253-221-1200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 0402208146
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | DH-2431-0
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License Number State | HI
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