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General NPI Number Information
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NPI Number | 1649583857
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Entity Type | Organization
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Legal Business Name | DR. KMIECK'S DENTAL HEALTH SERVICE INC
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Dates
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Enumeration Date | 07/16/2010
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Last Update Date | 07/16/2010
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Provider Practice Location Address
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Address Line | 7057 W 130TH ST
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City | PARMA HEIGHTS
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State | OH
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Zip | 44130-7841
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Country | US
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Telephone | 440-888-9755
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Fax | 440-888-8763
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Provider Business Mailing Address
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Address Line | 7057 W 130TH ST
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City | PARMA HEIGHTS
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State | OH
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Zip | 44130-7841
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Country | US
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Telephone | 440-888-9755
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Fax | 440-888-8763
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KENNETH THOMAS KMIECK
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Credential | DDS
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Telephone | 440-888-9755
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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 | DS030029L
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License Number State | PA
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