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General NPI Number Information
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NPI Number | 1770302564
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Entity Type | Organization
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Legal Business Name | TIMOTHY KITLEY DMD PC
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Dates
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Enumeration Date | 10/08/2024
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Last Update Date | 10/08/2024
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Provider Practice Location Address
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Address Line | 700 E OGDEN AVE STE 110
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City | WESTMONT
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State | IL
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Zip | 60559-1283
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Country | US
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Telephone | 630-986-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 700 E OGDEN AVE STE 110
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City | WESTMONT
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State | IL
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Zip | 60559-1283
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY KITLEY
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Credential | DMD
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Telephone | 412-736-9964
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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 |
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License Number State |
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