Provider Demographics
NPI:1710518543
Name:TKR ORAL MAXILLOFACIAL SURGEONS CORPORATION
Entity Type:Organization
Organization Name:TKR ORAL MAXILLOFACIAL SURGEONS CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRSTAL
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-731-6688
Mailing Address - Street 1:914 JOHNSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4938
Mailing Address - Country:US
Mailing Address - Phone:681-207-3959
Mailing Address - Fax:681-207-3958
Practice Address - Street 1:914 JOHNSTOWN RD
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4938
Practice Address - Country:US
Practice Address - Phone:681-207-3959
Practice Address - Fax:681-207-3958
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-30
Last Update Date:2020-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty