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General NPI Number Information
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NPI Number | 1598207813
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Entity Type | Organization
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Legal Business Name | KAISER FAMILY DENTISTRY
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Dates
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Enumeration Date | 11/17/2016
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Last Update Date | 11/17/2016
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Provider Practice Location Address
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Address Line | 6101 GRACE PARK DR
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City | MORRISVILLE
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State | NC
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Zip | 27560-6003
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Country | US
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Telephone | 919-571-2484
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Fax |
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Provider Business Mailing Address
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Address Line | 6101 GRACE PARK DR
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City | MORRISVILLE
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State | NC
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Zip | 27560-6003
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Country | US
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Telephone | 919-571-2484
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | AUDREY KAISER
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Credential | DDS
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Telephone | 919-571-2484
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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 | 9365
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License Number State | NC
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