Provider Demographics
NPI:1699781872
Name:MAH, JONATHAN WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:MAH
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:949 IKENA CIR
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96821-2555
Mailing Address - Country:US
Mailing Address - Phone:808-741-3225
Mailing Address - Fax:808-959-3675
Practice Address - Street 1:111 E PUAINAKO ST
Practice Address - Street 2:STE. A-104
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-5288
Practice Address - Country:US
Practice Address - Phone:808-959-3433
Practice Address - Fax:808-959-3675
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 16171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI1672867OtherUNITED CONCORDIA
HI055406-02Medicaid
HI61617OtherHAWAII DENTAL SERVICE
HIL06380-4OtherHMSA