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General NPI Number Information
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NPI Number | 1750742730
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Entity Type | Organization
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Legal Business Name | KAUAI FAMILY DENTISTRY, INC.
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Dates
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Enumeration Date | 03/17/2016
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Last Update Date | 08/17/2016
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Provider Practice Location Address
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Address Line | 437 PAPALOA RD
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City | KAPAA
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State | HI
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Zip | 96746-1454
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Country | US
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Telephone | 808-823-8707
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Fax |
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Provider Business Mailing Address
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Address Line | 437 PAPALOA RD
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City | KAPAA
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State | HI
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Zip | 96746-1454
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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 | PRESIDENT
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Name | DR. KAIMANA GOO-RAHTZ
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Credential | D.M.D.
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Telephone | 808-823-8707
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2531
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License Number State | HI
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