12D2198504 CLIA NUMBER - KONA CENTER OF FACIAL SURGERY

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Laboratory Demographics

CLIA Number: 12D2198504

Facility Name: KONA CENTER OF FACIAL SURGERY

Facility Address:
65-1230 MAMALAHOA HWY, STE C-10
KAMUELA, HI
ZIP 96743
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Facility Phone Number: 808 885-9000

Facility Type: Practitioner Other

Certificate Type: Waiver

NPI Number: 1063647931

Taxonomy: 1223S0112X - Dentist
An oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region.

CLIA Record

Field Name	Field Value
CLIA Number	12D2198504
LAB Type	Practitioner Other
Facility Name	KONA CENTER OF FACIAL SURGERY
Street	65-1230 MAMALAHOA HWY, STE C-10
City	KAMUELA
State	HI
ZIP	96743
Phone	808 885-9000
CertificateType	4
CertificateEffectiveDate	11/2/2022
CertificateExpirationDate	11/1/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024