Basic Information
| Provider Information | |||||||||
| NPI: | 1104087303 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEAD | ||||||||
| FirstName: | BENJAMIN | ||||||||
| MiddleName: | KARL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | D.D.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 244 HAILI STREET | ||||||||
| Address2: | BLDG B | ||||||||
| City: | HILO | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967202975 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089614071 | ||||||||
| FaxNumber: | 8087751314 | ||||||||
| Practice Location | |||||||||
| Address1: | 16-192 PILIMUA ST. | ||||||||
| Address2: | |||||||||
| City: | KEA'AU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967498134 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089300400 | ||||||||
| FaxNumber: | 8087751314 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2008 | ||||||||
| LastUpdateDate: | 04/19/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DT 2347 | HI | Y | Dental Providers | Dentist | General Practice |
No ID Information.