Provider Demographics
NPI:1003900937
Name:KIELT, LAURENCE WILLIAM (DDS)
Entity type:Individual
Prefix:
First Name:LAURENCE
Middle Name:WILLIAM
Last Name:KIELT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 SO. KINGS HWY. SUITE 6
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2579
Mailing Address - Country:US
Mailing Address - Phone:856-429-7811
Mailing Address - Fax:856-429-7819
Practice Address - Street 1:303 SO. KINGS HWY. SUITE 6
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08054-2579
Practice Address - Country:US
Practice Address - Phone:856-429-7811
Practice Address - Fax:856-429-7819
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ164901223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics