Provider Demographics
NPI: | 1962400457 |
---|---|
Name: | ROBERT L KIEHL, DDS PS |
Entity type: | Organization |
Organization Name: | ROBERT L KIEHL, DDS PS |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PRES. |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | ROBERT |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | KIEHL |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DDS |
Authorized Official - Phone: | 253-584-1314 |
Mailing Address - Street 1: | 5920 100TH ST SW |
Mailing Address - Street 2: | STE 9 |
Mailing Address - City: | LAKEWOOD |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98499-2751 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 253-584-1314 |
Mailing Address - Fax: | 253-584-5924 |
Practice Address - Street 1: | 5920 100TH ST SW |
Practice Address - Street 2: | STE 9 |
Practice Address - City: | LAKEWOOD |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98499-2751 |
Practice Address - Country: | US |
Practice Address - Phone: | 253-584-1314 |
Practice Address - Fax: | 253-584-5924 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2005-07-08 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
WA | 3766 | 1223G0001X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 1223G0001X | Dental Providers | Dentist | General Practice | Group - Single Specialty |