Provider Demographics
NPI:1528726700
Name:MAUI KIDS DENTISTRY LLC
Entity type:Organization
Organization Name:MAUI KIDS DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDANIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-937-4841
Mailing Address - Street 1:53 S PUUNENE AVE STE 115
Mailing Address - Street 2:
Mailing Address - City:KAHULUI
Mailing Address - State:HI
Mailing Address - Zip Code:96732-2192
Mailing Address - Country:US
Mailing Address - Phone:702-937-4841
Mailing Address - Fax:
Practice Address - Street 1:53 S PUUNENE AVE STE 115
Practice Address - Street 2:
Practice Address - City:KAHULUI
Practice Address - State:HI
Practice Address - Zip Code:96732-2192
Practice Address - Country:US
Practice Address - Phone:702-937-4841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental