Provider Demographics
NPI:1699507806
Name:MALAMA DENTAL
Entity type:Organization
Organization Name:MALAMA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:KOCKELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:808-741-7292
Mailing Address - Street 1:1497 MILOIKI ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-3229
Mailing Address - Country:US
Mailing Address - Phone:808-741-7292
Mailing Address - Fax:
Practice Address - Street 1:45 AULIKE ST
Practice Address - Street 2:
Practice Address - City:KAILUA
Practice Address - State:HI
Practice Address - Zip Code:96734-2754
Practice Address - Country:US
Practice Address - Phone:808-262-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-16
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty