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General NPI Number Information
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NPI Number | 1306012174
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Entity Type | Organization
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Legal Business Name | JOSEPH F. KALLIAL, D.M.D. LLC
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Dates
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Enumeration Date | 05/01/2008
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Last Update Date | 05/01/2008
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Provider Practice Location Address
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Address Line | 5960 HOWDERSHELL RD SUITE 202
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City | HAZELWOOD
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State | MO
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Zip | 63042-4100
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Country | US
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Telephone | 314-731-5155
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Fax | 314-731-2321
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Provider Business Mailing Address
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Address Line | 5960 HOWDERSHELL RD SUITE 202
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City | HAZELWOOD
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State | MO
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Zip | 63042-4100
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Country | US
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Telephone | 314-731-5155
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Fax | 314-731-2321
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JOSEPH FRANCIS KALLIAL
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Credential | D.M.D.
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Telephone | 314-731-5155
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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 | 015599
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License Number State | MO
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