Provider Demographics
NPI:1336391077
Name:THE DENTIST-JEFFREY C KIRIAN DDS LLC
Entity type:Organization
Organization Name:THE DENTIST-JEFFREY C KIRIAN DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-366-1236
Mailing Address - Street 1:1175 MOUNT VERNON RD
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-3034
Mailing Address - Country:US
Mailing Address - Phone:740-366-1236
Mailing Address - Fax:740-364-1972
Practice Address - Street 1:1175 MOUNT VERNON RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-3034
Practice Address - Country:US
Practice Address - Phone:740-366-1236
Practice Address - Fax:740-364-1972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30022375122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty