Provider Demographics
NPI:1053821991
Name:KITCHIN DENTISTRY, PA
Entity Type:Organization
Organization Name:KITCHIN DENTISTRY, PA
Other - Org Name:KITCHIN COSMETIC AND FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:LLOYD
Authorized Official - Last Name:KITCHIN
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:973-584-2533
Mailing Address - Street 1:40 MAIN STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SUCCASUNNA
Mailing Address - State:NJ
Mailing Address - Zip Code:07876
Mailing Address - Country:US
Mailing Address - Phone:973-584-2533
Mailing Address - Fax:973-584-4363
Practice Address - Street 1:40 MAIN STREET
Practice Address - Street 2:SUITE 101
Practice Address - City:SUCCASUNNA
Practice Address - State:NJ
Practice Address - Zip Code:07876
Practice Address - Country:US
Practice Address - Phone:973-584-2533
Practice Address - Fax:973-584-4363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-05
Last Update Date:2017-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI013842001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty