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General NPI Number Information
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NPI Number | 1750392007
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Entity Type | Organization
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Legal Business Name | KILMER AND COSTANZO A GENERAL PARTNERSHIP
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6307 N FRESNO ST STE 101
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City | FRESNO
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State | CA
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Zip | 93710
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Country | US
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Telephone | 559-435-5033
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Fax | 559-435-5048
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Provider Business Mailing Address
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Address Line | 6307 N FRESNO ST STE 101
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City | FRESNO
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State | CA
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Zip | 93710
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Country | US
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Telephone | 559-435-5033
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Fax | 559-435-5048
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. CAROL J RODRIGUEZ
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Credential |
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Telephone | 559-435-5033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 50234
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 234622
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License Number State | CA
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