Provider Demographics
NPI:1063959864
Name:KYGER DENTAL ASSOCIATES INC
Entity type:Organization
Organization Name:KYGER DENTAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:VIRGIL
Authorized Official - Last Name:KYGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-446-7806
Mailing Address - Street 1:878 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1391
Mailing Address - Country:US
Mailing Address - Phone:740-446-7806
Mailing Address - Fax:740-446-4840
Practice Address - Street 1:878 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1391
Practice Address - Country:US
Practice Address - Phone:740-446-7806
Practice Address - Fax:740-446-4840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30015773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH010551336OtherTAX ID
OH010551367OtherTAX ID