Individual
KENNETH FASIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4643B WAIMEA CANYON DRIVE, WAIMEA, HI 96796
(808) 240-0150
(808) 338-9646
Mailing address
PO BOX 3990, LIHUE, HI 96766-6990
(808) 240-0100
(808) 245-8867
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
CSDT3
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000252361
HMSA WEST
HI
05
—
523979-02
—
HI
01
—
CSDT3
HDS
HI
Enumeration date
12/18/2006
Last updated
07/09/2007
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