MEDICARE: KAC DENTAL, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center	0401415867	VA

General Provider Information

NPI Number	:	1528569563
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAC DENTAL, PC

Provider Business Mailing Address
First Line	:	7834 FOREST HILL AVE STE 1
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1974
Country	:	US
Telephone Number	:	804-272-2205
Fax Number	:	804-272-2111

Provider Business Practice Location Address
First Line	:	7834 FOREST HILL AVE STE 1
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23225-1974
Country	:	US
Telephone Number	:	804-272-2205
Fax Number	:	804-272-2111

Authorized Official
Title or Position	:	OWNER
Name	:	DR. KEVIN CRISCITIELLO
Credential	:
Telephone Number	:	804-272-2205

Provider Enumeration Date	:	02/26/2018
Last Update Date	:	03/10/2021

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