Provider Demographics
NPI:1861600132
Name:KAISER FAMILY DENTISTRY, INC.
Entity type:Organization
Organization Name:KAISER FAMILY DENTISTRY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KAISER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-352-4661
Mailing Address - Street 1:1064 W WOOSTER ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:OH
Mailing Address - Zip Code:43402-2633
Mailing Address - Country:US
Mailing Address - Phone:419-352-4661
Mailing Address - Fax:419-352-4944
Practice Address - Street 1:1064 W WOOSTER ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:OH
Practice Address - Zip Code:43402-2633
Practice Address - Country:US
Practice Address - Phone:419-352-4661
Practice Address - Fax:419-352-4944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-19
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34143341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty