Provider Demographics
NPI:1487153615
Name:KFDC, LLC
Entity type:Organization
Organization Name:KFDC, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:DODSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-283-7077
Mailing Address - Street 1:PO BOX 1671
Mailing Address - Street 2:
Mailing Address - City:LAHAINA
Mailing Address - State:HI
Mailing Address - Zip Code:96767-1671
Mailing Address - Country:US
Mailing Address - Phone:808-283-7077
Mailing Address - Fax:
Practice Address - Street 1:10 HOOHUI RD STE 208
Practice Address - Street 2:
Practice Address - City:LAHAINA
Practice Address - State:HI
Practice Address - Zip Code:96761-9258
Practice Address - Country:US
Practice Address - Phone:808-665-0888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ALOHA FAMILY DENTAL CENTERS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental