Provider Demographics
NPI:1083717094
Name:KRESHTOOL & KIM ENDODONTICS PA
Entity Type:Organization
Organization Name:KRESHTOOL & KIM ENDODONTICS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:KRESHTOOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-652-3556
Mailing Address - Street 1:1815 W 13TH STREET
Mailing Address - Street 2:SUITE #7
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4054
Mailing Address - Country:US
Mailing Address - Phone:302-652-3556
Mailing Address - Fax:302-654-8088
Practice Address - Street 1:1815 W 13TH STREET
Practice Address - Street 2:SUITE #7
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-4054
Practice Address - Country:US
Practice Address - Phone:302-652-3556
Practice Address - Fax:302-654-8088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0001186931Medicaid
264118OtherUNITED CONCORDIA