Provider Demographics
NPI:1194125484
Name:KAHALA SMILE PROFESSIONALS, L.L.C.
Entity type:Organization
Organization Name:KAHALA SMILE PROFESSIONALS, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WADA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-732-9232
Mailing Address - Street 1:4211 WAIALAE AVE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96816-5319
Mailing Address - Country:US
Mailing Address - Phone:808-732-9232
Mailing Address - Fax:808-739-2132
Practice Address - Street 1:4211 WAIALAE AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96816-5319
Practice Address - Country:US
Practice Address - Phone:808-732-9232
Practice Address - Fax:808-739-2132
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty