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General NPI Number Information
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NPI Number | 1740263029
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Entity Type | Individual
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Provider Name | PAUL E. KITTLE JR. DDS
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Gender | Male
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Dates
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Enumeration Date | 11/21/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 309 S 2ND ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-2803
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Country | US
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Telephone | 913-651-9800
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Fax | 913-651-8559
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Provider Business Mailing Address
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Address Line | 309 S 2ND ST
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City | LEAVENWORTH
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State | KS
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Zip | 66048-2803
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Country | US
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Telephone | 913-651-9800
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Fax | 913-651-8559
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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 | 6806
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 4721
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 2004025887
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License Number State | MO
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