Healthcare Provider Details

I. General information

NPI: 1104376771
Provider Name (Legal Business Name): DARNELL KAIGLER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2016
Last Update Date: 10/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 MACK AVE
DETROIT MI
48201-2136
US

IV. Provider business mailing address

430 MACK AVE
DETROIT MI
48201-2136
US

V. Phone/Fax

Practice location:
  • Phone: 313-936-0819
  • Fax: 313-936-0818
Mailing address:
  • Phone: 313-936-0819
  • Fax: 313-936-0818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2901017652
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number2901018329
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901018534
License Number StateMI

VIII. Authorized Official

Name: DR. DARNELL KAIGLER JR.
Title or Position: PRESIDENT
Credential: DDS, MS, PHD
Phone: 313-936-0819