=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114811668
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KILIE JO PLETCHER DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2025
-----------------------------------------------------
Last Update Date | 06/06/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 716 ADAIR AVE
-----------------------------------------------------
City | ZANESVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43701-2843
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-891-9000
-----------------------------------------------------
Fax | 740-891-9001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6040 FULTONROSE RD
-----------------------------------------------------
City | ROSEVILLE
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43777-9747
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 740-583-4075
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 30.028058
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------