Provider Demographics
NPI:1326563289
Name:AFINIA DENTAL-KILLGORE NORTH, INC
Entity Type:Organization
Organization Name:AFINIA DENTAL-KILLGORE NORTH, INC
Other - Org Name:AFINIA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KILLGORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-739-7257
Mailing Address - Street 1:4874 WUNNENBERG WAY
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:45069-4863
Mailing Address - Country:US
Mailing Address - Phone:513-746-8228
Mailing Address - Fax:
Practice Address - Street 1:4874 WUNNENBERG WAY
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-4863
Practice Address - Country:US
Practice Address - Phone:513-746-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental