Provider Demographics
NPI:1104065085
Name:VODZAK, KEITH A (DMD MSD, ORTHO)
Entity type:Individual
Prefix:DR
First Name:KEITH
Middle Name:A
Last Name:VODZAK
Suffix:
Gender:M
Credentials:DMD MSD, ORTHO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42-125 KOOKU PLACE
Mailing Address - Street 2:
Mailing Address - City:KAILUA
Mailing Address - State:HI
Mailing Address - Zip Code:96734-5710
Mailing Address - Country:US
Mailing Address - Phone:808-393-2020
Mailing Address - Fax:
Practice Address - Street 1:377 KEAHOLE ST.
Practice Address - Street 2:SUITE #211
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825
Practice Address - Country:US
Practice Address - Phone:808-393-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT-16661223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics