Provider Demographics
NPI:1730643461
Name:KIRKWOOD FAMILY DENTAL
Entity Type:Organization
Organization Name:KIRKWOOD FAMILY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:WINKLER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:314-909-9200
Mailing Address - Street 1:333 S KIRKWOOD ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:KIRKWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63122
Mailing Address - Country:US
Mailing Address - Phone:314-909-9200
Mailing Address - Fax:314-909-9212
Practice Address - Street 1:333 S KIRKWOOD ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:KIRKWOOD
Practice Address - State:MO
Practice Address - Zip Code:63122
Practice Address - Country:US
Practice Address - Phone:314-909-9200
Practice Address - Fax:314-909-9212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty