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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