Provider Demographics
NPI:1528569563
Name:KAC DENTAL, PC
Entity Type:Organization
Organization Name:KAC DENTAL, PC
Other - Org Name:KAC DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRISCITIELLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:804-272-2205
Mailing Address - Street 1:7834 FOREST HILL AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23225-1974
Mailing Address - Country:US
Mailing Address - Phone:804-272-2205
Mailing Address - Fax:804-272-2111
Practice Address - Street 1:7834 FOREST HILL AVE STE 1
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23225-1974
Practice Address - Country:US
Practice Address - Phone:804-272-2205
Practice Address - Fax:804-272-2111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-26
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415867261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental