Provider Demographics
NPI:1104087303
Name:MEAD, BENJAMIN KARL (DDS)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:KARL
Last Name:MEAD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 HAILI STREET
Mailing Address - Street 2:BLDG B
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-2975
Mailing Address - Country:US
Mailing Address - Phone:808-961-4071
Mailing Address - Fax:808-775-1314
Practice Address - Street 1:16-192 PILIMUA ST.
Practice Address - Street 2:
Practice Address - City:KEA'AU
Practice Address - State:HI
Practice Address - Zip Code:96749-8134
Practice Address - Country:US
Practice Address - Phone:808-930-0400
Practice Address - Fax:808-775-1314
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 23471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice