=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841189222
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MIRANDA KALASKEY, DDS, PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2025
-----------------------------------------------------
Last Update Date | 07/01/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | KALASKEY PEDIATRIC DENTISTRY 738 OLD AIRPORT ROAD
-----------------------------------------------------
City | CHAPMANVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-738-7555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | KALASKEY PEDIATRIC DENTISTRY 738 OLD AIRPORT ROAD
-----------------------------------------------------
City | CHAPMANVILLE
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 25508
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-738-7555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. MIRANDA KALASKEY
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 304-543-7555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------