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General NPI Number Information
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NPI Number | 1053821991
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Entity Type | Organization
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Legal Business Name | KITCHIN DENTISTRY, PA
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Dates
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Enumeration Date | 10/05/2017
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Last Update Date | 10/05/2017
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Provider Practice Location Address
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Address Line | 40 MAIN STREET SUITE 101
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City | SUCCASUNNA
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State | NJ
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Zip | 07876
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Country | US
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Telephone | 973-584-2533
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Fax | 973-584-4363
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Provider Business Mailing Address
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Address Line | 40 MAIN STREET SUITE 101
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City | SUCCASUNNA
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State | NJ
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Zip | 07876
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Country | US
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Telephone | 973-584-2533
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Fax | 973-584-4363
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Authorized Official
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Title or Position | OWNER / PRESIDENT
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Name | DR. ALBERT LLOYD KITCHIN III
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Credential | DMD
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Telephone | 973-584-2533
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI01384200
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License Number State | NJ
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