MEDICARE: DR. LINDSEY KALOLENA KAWAHAKUI D.D.S.

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
1	1223G0001X	General Practice Dentistry	DEN.00202856	CO

General Provider Information

NPI Number	:	1821430414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDSEY KALOLENA KAWAHAKUI D.D.S.

Provider Business Mailing Address
First Line	:	2047 COLUMBIA DR
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-3279
Country	:	US
Telephone Number	:	719-566-0206
Fax Number	:	719-561-1095

Provider Business Practice Location Address
First Line	:	2047 COLUMBIA DR
Second Line	:
City	:	PUEBLO
State	:	CO
Zip	:	81005-3279
Country	:	US
Telephone Number	:	719-566-0206
Fax Number	:	719-561-1095

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/23/2013
Last Update Date	:	11/20/2023

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