Healthcare Provider Details

I. General information

NPI: 1619028636
Provider Name (Legal Business Name): MICHAEL JOHN KANIA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

417 N CHURCH ST
ASHEBORO NC
27203-4701
US

IV. Provider business mailing address

417 N CHURCH ST
ASHEBORO NC
27203-4701
US

V. Phone/Fax

Practice location:
  • Phone: 336-629-9115
  • Fax:
Mailing address:
  • Phone: 336-629-9115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5610
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: