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Organization
MARK K. KOIZUMI, D.D.S., INC.
Active
Organization
MARK K. KOIZUMI, D.D.S., INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK K. KOIZUMI D.D.S. (PRESIDENT)
(808) 935-1149
Entity
Organization
Contact information
Practice address
275 PONAHAWAI ST, SUITE 103, HILO, HI 96720-3074
(808) 935-1149
Mailing address
275 PONAHAWAI ST, SUITE 103, HILO, HI 96720-3074
(808) 935-1149
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
DT-1380
HI
Other
Enumeration date
05/09/2007
Last updated
06/29/2012
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