Provider Demographics
NPI:1295111615
Name:MAUI DENTAL PROFESSIONALS LLC
Entity type:Organization
Organization Name:MAUI DENTAL PROFESSIONALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:GIRARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-268-5175
Mailing Address - Street 1:54 MAUI LANI PKWY
Mailing Address - Street 2:SUITE 2020
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-2467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:54 MAUI LANI PKWY
Practice Address - Street 2:SUITE 2020
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-2467
Practice Address - Country:US
Practice Address - Phone:808-268-5175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-07
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT2142122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty