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General NPI Number Information
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NPI Number | 1801037585
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Entity Type | Organization
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Legal Business Name | KONA 'OHANA DENTAL, INC.
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Dates
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Enumeration Date | 03/10/2009
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Last Update Date | 03/10/2009
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Provider Practice Location Address
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Address Line | 76-6225 KUAKINI HWY SUITE B203
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City | KAILUA KONA
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State | HI
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Zip | 96740-3211
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Country | US
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Telephone | 808-629-6167
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Fax | 808-334-0205
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Provider Business Mailing Address
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Address Line | 76-6225 KUAKINI HWY SUITE B203
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City | KAILUA KONA
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State | HI
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Zip | 96740-3211
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Country | US
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Telephone | 808-629-6167
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Fax | 808-334-0205
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARK Y. MURAMOTO
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Credential | DDS
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Telephone | 808-329-6167
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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 | DT1584
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License Number State | HI
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