Provider Demographics
NPI:1891816294
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:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:B
Authorized Official - Last Name:KALNIZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-536-7265
Mailing Address - Street 1:6029 MANLEY RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-1534
Mailing Address - Country:US
Mailing Address - Phone:419-536-7265
Mailing Address - Fax:419-724-1651
Practice Address - Street 1:6029 MANLEY RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1534
Practice Address - Country:US
Practice Address - Phone:419-536-7265
Practice Address - Fax:419-724-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0208571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTIN