Provider Demographics
NPI:1114205929
Name:KIROLOS, MARYANA F (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARYANA
Middle Name:F
Last Name:KIROLOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 KENTOM DR
Mailing Address - Street 2:
Mailing Address - City:OLIVETTE
Mailing Address - State:MO
Mailing Address - Zip Code:63132-4108
Mailing Address - Country:US
Mailing Address - Phone:314-442-6446
Mailing Address - Fax:314-442-6446
Practice Address - Street 1:2608 STATE ST
Practice Address - Street 2:
Practice Address - City:EAST SAINT LOUIS
Practice Address - State:IL
Practice Address - Zip Code:62205-2325
Practice Address - Country:US
Practice Address - Phone:618-857-2300
Practice Address - Fax:618-857-2302
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190288061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice