Provider Demographics
NPI:1699444950
Name:MCILHATTEN, ALEXANDER (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXANDER
Middle Name:
Last Name:MCILHATTEN
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 1:25-161 UA NAHELE ST
Mailing Address - Street 2:
Mailing Address - City:HILO
Mailing Address - State:HI
Mailing Address - Zip Code:96720-1357
Mailing Address - Country:US
Mailing Address - Phone:508-642-9190
Mailing Address - Fax:
Practice Address - Street 1:111 E PUAINAKO ST STE 320
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-6549
Practice Address - Country:US
Practice Address - Phone:808-443-5214
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1002706-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice