Provider Demographics
NPI:1912253816
Name:KITNER, PAMUELA A (RDH)
Entity type:Individual
Prefix:
First Name:PAMUELA
Middle Name:A
Last Name:KITNER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5385 WOODSTOCK TOWER RD
Mailing Address - Street 2:
Mailing Address - City:FORT VALLEY
Mailing Address - State:VA
Mailing Address - Zip Code:22652-2134
Mailing Address - Country:US
Mailing Address - Phone:540-933-6529
Mailing Address - Fax:
Practice Address - Street 1:1002 AMHERST ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-3323
Practice Address - Country:US
Practice Address - Phone:540-667-7600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0402002284124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist