Provider Demographics
NPI:1053862961
Name:BEST CARE DENTAL
Entity Type:Organization
Organization Name:BEST CARE DENTAL
Other - Org Name:DR. MARYANA KIROLOS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KIROLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-240-6858
Mailing Address - Street 1:310 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2606
Mailing Address - Country:US
Mailing Address - Phone:636-240-6858
Mailing Address - Fax:636-272-4278
Practice Address - Street 1:310 E ELM ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2606
Practice Address - Country:US
Practice Address - Phone:636-240-6858
Practice Address - Fax:636-272-4278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20125019136122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1114205929Medicaid