Provider Demographics
NPI:1043438674
Name:K&W FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:K&W FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:KELLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:732-525-0049
Mailing Address - Street 1:236 ERNSTON ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:PARLIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08859-1926
Mailing Address - Country:US
Mailing Address - Phone:732-525-0049
Mailing Address - Fax:732-525-0089
Practice Address - Street 1:236 ERNSTON ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:PARLIN
Practice Address - State:NJ
Practice Address - Zip Code:08859-1926
Practice Address - Country:US
Practice Address - Phone:732-525-0049
Practice Address - Fax:732-525-0089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty