Provider Demographics
NPI:1205262045
Name:AFINIA DENTAL KILLGORE BRIDGETOWN INC
Entity type:Organization
Organization Name:AFINIA DENTAL KILLGORE BRIDGETOWN INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER - PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:KILLGORE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:513-739-9117
Mailing Address - Street 1:9415 FIELDS ERTEL RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45249-8212
Mailing Address - Country:US
Mailing Address - Phone:513-746-8228
Mailing Address - Fax:
Practice Address - Street 1:6371 BRIDGETOWN RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45248-2943
Practice Address - Country:US
Practice Address - Phone:513-746-8228
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-25
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300228801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty