# BIG KAHUNA DENTAL, LLC DBA ALOHA DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073928305
- **Authorized official:** KASE PEERY (BUSINESS MANAGER)
- **Authorized official phone:** (801) 969-9669

## Contact information

- **Practice address:** 2792 S 5600 W, WEST VALLEY CITY, UT 84120-5590
- **Practice address phone:** (801) 969-9669
- **Practice address fax:** (801) 969-9779
- **Mailing address:** 2792 S 5600 W, WEST VALLEY CITY, UT 84120-5590
- **Mailing address phone:** (801) 969-9669
- **Mailing address fax:** (801) 969-9779

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5672733-9922 | UT | — |
| 1223G0001X | General Practice Dentistry | 8919236-9921 | UT | — |
| 1223P0221X | Pediatric Dentistry | 7579613-9923 | UT | Yes |
| 1223P0221X | Pediatric Dentistry | 9474332-9922 | UT | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 135181-9924 | UT | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | 317724-8903 | UT | — |

## Other

- **Enumeration date:** 06/25/2014
- **Last updated:** 03/23/2016