Provider Demographics
NPI:1093257693
Name:JOHN KITTRELL DDS
Entity Type:Organization
Organization Name:JOHN KITTRELL DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:KITTRELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-359-6471
Mailing Address - Street 1:2600 GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-4366
Mailing Address - Country:US
Mailing Address - Phone:804-359-6471
Mailing Address - Fax:
Practice Address - Street 1:2600 GROVE AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23220-4366
Practice Address - Country:US
Practice Address - Phone:804-359-6471
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL VIRGINIA DENTAL CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA59491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty