Provider Demographics
NPI:1942501390
Name:DAWNIE L. KILDOO PA
Entity Type:Organization
Organization Name:DAWNIE L. KILDOO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAWNIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KILDOO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-625-0130
Mailing Address - Street 1:267 W DUVAL RD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:GREEN VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85614-4344
Mailing Address - Country:US
Mailing Address - Phone:520-625-0131
Mailing Address - Fax:520-625-6998
Practice Address - Street 1:267 W DUVAL RD
Practice Address - Street 2:SUITE 105
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614-4344
Practice Address - Country:US
Practice Address - Phone:520-625-0131
Practice Address - Fax:520-625-6998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ53311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty