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General NPI Number Information
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NPI Number | 1336391077
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Entity Type | Organization
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Legal Business Name | THE DENTIST-JEFFREY C KIRIAN DDS LLC
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 1175 MOUNT VERNON RD
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City | NEWARK
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State | OH
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Zip | 43055-3034
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Country | US
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Telephone | 740-366-1236
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Fax | 740-364-1972
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Provider Business Mailing Address
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Address Line | 1175 MOUNT VERNON RD
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City | NEWARK
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State | OH
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Zip | 43055-3034
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Country | US
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Telephone | 740-366-1236
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Fax | 740-364-1972
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Authorized Official
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Title or Position | OWNER
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Name | JEFFREY KIRIAN
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Credential |
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Telephone | 740-366-1236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30022375
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License Number State | OH
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