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General NPI Number Information
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NPI Number | 1861600132
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Entity Type | Organization
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Legal Business Name | KAISER FAMILY DENTISTRY, INC.
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Dates
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Enumeration Date | 05/19/2007
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 1064 W WOOSTER ST
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City | BOWLING GREEN
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State | OH
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Zip | 43402-2633
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Country | US
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Telephone | 419-352-4661
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Fax | 419-352-4944
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Provider Business Mailing Address
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Address Line | 1064 W WOOSTER ST
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City | BOWLING GREEN
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State | OH
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Zip | 43402-2633
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Country | US
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Telephone | 419-352-4661
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Fax | 419-352-4944
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEFFREY T. KAISER
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Credential | D.D.S.
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Telephone | 419-352-4661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 3414334
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License Number State | OH
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