Provider Demographics
NPI:1508040494
Name:KALNIZ DENTAL-MAUMEE, LLC
Entity Type:Organization
Organization Name:KALNIZ DENTAL-MAUMEE, LLC
Other - Org Name:REYNOLDS CORNERS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:KALNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-536-7265
Mailing Address - Street 1:1642 RALSTON CIR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-3801
Mailing Address - Country:US
Mailing Address - Phone:419-536-7265
Mailing Address - Fax:
Practice Address - Street 1:447 W DUSSEL DR
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-4208
Practice Address - Country:US
Practice Address - Phone:419-536-7265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-MULTIPLE1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH447 W DUSSEL DRIVEOther447 W DUSSEL DRIVE MAUMEE OH 43537