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General NPI Number Information
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NPI Number | 1124213517
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Entity Type | Individual
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Provider Name | TIMOTHY A KITLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 09/10/2007
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 700 E OGDEN AVE STE 110
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City | WESTMONT
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State | IL
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Zip | 60559-1283
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Country | US
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Telephone | 630-986-1234
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Fax | 630-828-2984
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Provider Business Mailing Address
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Address Line | 700 E OGDEN AVE STE 110
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City | WESTMONT
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State | IL
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Zip | 60559-1283
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Country | US
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Telephone | 630-986-1234
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Fax | 630-828-2984
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 019030647
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License Number State | IL
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