Individual
KELLY DIANE DAVIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
970 N KALAHEO AVE STE A101, KAILUA, HI 96734-1868
(808) 254-2339
Mailing address
602 HAMAKUA PL, KAILUA, HI 96734-3924
(856) 419-8707
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH-2142
HI
124Q00000X
Dental Hygienist
HI-01081900
NJ
Other
Enumeration date
05/25/2021
Last updated
05/25/2021
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