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NPI Code Detail

MEDICARE: HAWAII DENTAL GROUP, INC.

MEDICARE: HAWAII DENTAL GROUP, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223E0200XEndodontics
21223P0221XPediatric Dentistry
31223P0300XPeriodontics
41223P0700XProsthodontics
51223X0400XOrthodontics and Dentofacial Orthopedics Dentistry
6124Q00000XDental Hygienist
7126800000XDental Assistant
81223G0001XGeneral Practice Dentistry

General Provider Information

NPI Number : 1780992503
Entity Type Code : Organization
Provider Name (Legal Business Name) : HAWAII DENTAL GROUP, INC.
Provider Business Mailing Address
First Line : 500 ALA MOANA BLVD
Second Line : SUITE 7-220
City : HONOLULU
State : HI
Zip : 96813-4920
Country : US
Telephone Number : 808-523-3103
Fax Number : 808-523-3122
Provider Business Practice Location Address
First Line : 68-1845 WAIKOLOA RD
Second Line : SUITE 205
City : WAIKOLOA
State : HI
Zip : 96738-5584
Country : US
Telephone Number : 808-883-9100
Fax Number : 808-883-1469
Authorized Official
Title or Position : CHIEF EXECUTIVE OFFICER
Name : DR. GARY KONDO
Credential :
Telephone Number : 808-523-3103
Provider Enumeration Date : 09/14/2010
Last Update Date : 09/14/2010

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Directions to “HAWAII DENTAL GROUP, INC. ” Practice Location

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