Provider Demographics
NPI:1104376771
Name:DARNELL KAIGLER PLLC
Entity Type:Organization
Organization Name:DARNELL KAIGLER PLLC
Other - Org Name:DETROIT DENTAL SPECIALTY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DARNELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIGLER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS, MS, PHD
Authorized Official - Phone:313-936-0819
Mailing Address - Street 1:430 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2136
Mailing Address - Country:US
Mailing Address - Phone:313-936-0819
Mailing Address - Fax:313-936-0818
Practice Address - Street 1:430 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2136
Practice Address - Country:US
Practice Address - Phone:313-936-0819
Practice Address - Fax:313-936-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-07
Last Update Date:2016-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901017652122300000X
MI29010183291223E0200X
MI29010185341223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty