=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083717094
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KRESHTOOL & KIM ENDODONTICS PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/06/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1815 W 13TH STREET SUITE #7
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-4054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-652-3556
-----------------------------------------------------
Fax | 302-654-8088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1815 W 13TH STREET SUITE #7
-----------------------------------------------------
City | WILMINGTON
-----------------------------------------------------
State | DE
-----------------------------------------------------
Zip | 19806-4054
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 302-652-3556
-----------------------------------------------------
Fax | 302-654-8088
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DANIEL R KRESHTOOL
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 302-652-3556
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------