Provider Demographics
NPI:1558454942
Name:DR. KVITKO & ASSOCIATES
Entity Type:Organization
Organization Name:DR. KVITKO & ASSOCIATES
Other - Org Name:DR KVITKO METNES & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIJANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:614-262-9588
Mailing Address - Street 1:4308 N HIGH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2610
Mailing Address - Country:US
Mailing Address - Phone:614-262-9588
Mailing Address - Fax:614-262-4159
Practice Address - Street 1:4308 N HIGH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2610
Practice Address - Country:US
Practice Address - Phone:614-262-9588
Practice Address - Fax:614-262-4159
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-30
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH164421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty