Healthcare Provider Details

I. General information

NPI: 1356577498
Provider Name (Legal Business Name): DARNELL KAIGLER D D S P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2009
Last Update Date: 12/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2671 W GRAND BLVD
DETROIT MI
48208-1203
US

IV. Provider business mailing address

2671 W GRAND BLVD
DETROIT MI
48208
US

V. Phone/Fax

Practice location:
  • Phone: 313-871-0436
  • Fax: 313-871-4807
Mailing address:
  • Phone: 313-871-0436
  • Fax: 313-871-4807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901018534
License Number StateMI

VIII. Authorized Official

Name: DR. DARNELL KAIGLER JR.
Title or Position: PERIODONTIST
Credential: D.D.S,M.S.,PH.D
Phone: 313-871-0436