Healthcare Provider Details

I. General information

NPI: 1629416508
Provider Name (Legal Business Name): PAUL CLIFFORD KITCHIN III DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 06/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7450 MATTAPONI LN
KING GEORGE VA
22485-3650
US

IV. Provider business mailing address

7450 MATTAPONI LN
KING GEORGE VA
22485-3650
US

V. Phone/Fax

Practice location:
  • Phone: 540-775-2201
  • Fax:
Mailing address:
  • Phone: 540-775-2201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0401004878
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: