Provider Demographics
NPI:1538405576
Name:KONA COAST DENTAL CARE, INC.
Entity type:Organization
Organization Name:KONA COAST DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:P.
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:BAYS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:808-329-8067
Mailing Address - Street 1:75-5591 PALANI RD STE 202
Mailing Address - Street 2:
Mailing Address - City:KAILUA KONA
Mailing Address - State:HI
Mailing Address - Zip Code:96740-3632
Mailing Address - Country:US
Mailing Address - Phone:808-329-8067
Mailing Address - Fax:
Practice Address - Street 1:75-5591 PALANI RD STE 202
Practice Address - Street 2:
Practice Address - City:KAILUA KONA
Practice Address - State:HI
Practice Address - Zip Code:96740-3632
Practice Address - Country:US
Practice Address - Phone:808-329-8067
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-19
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT 23971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty