Provider Demographics
NPI:1083803506
Name:THE KILZI DENTAL CORP
Entity Type:Organization
Organization Name:THE KILZI DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:KILZI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-739-0752
Mailing Address - Street 1:1113 S MAIN ST
Mailing Address - Street 2:# B
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882
Mailing Address - Country:US
Mailing Address - Phone:951-739-0752
Mailing Address - Fax:
Practice Address - Street 1:1113 S MAIN ST
Practice Address - Street 2:# B
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4412
Practice Address - Country:US
Practice Address - Phone:951-739-0752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA380681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty