Healthcare Provider Details

I. General information

NPI: 1366405516
Provider Name (Legal Business Name): KIRK A KALOGIANNIS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 PARK AVE SUITE 207
LYNDHURST NJ
07071-1462
US

IV. Provider business mailing address

211 EILEEN DR
CEDAR GROVE NJ
07009-1351
US

V. Phone/Fax

Practice location:
  • Phone: 201-507-5000
  • Fax:
Mailing address:
  • Phone: 973-256-5559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number18230
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: