Provider Demographics
NPI:1306012174
Name:JOSEPH F. KALLIAL, D.M.D. LLC
Entity Type:Organization
Organization Name:JOSEPH F. KALLIAL, D.M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:KALLIAL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-731-5155
Mailing Address - Street 1:5960 HOWDERSHELL RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAZELWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-4100
Mailing Address - Country:US
Mailing Address - Phone:314-731-5155
Mailing Address - Fax:314-731-2321
Practice Address - Street 1:5960 HOWDERSHELL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-4100
Practice Address - Country:US
Practice Address - Phone:314-731-5155
Practice Address - Fax:314-731-2321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0155991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty