Provider Demographics
NPI:1558461046
Name:KALBFELL, JOHN J SR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:J
Last Name:KALBFELL
Suffix:SR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:4265 OKEMOS RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-3285
Mailing Address - Country:US
Mailing Address - Phone:517-349-6111
Mailing Address - Fax:517-349-2843
Practice Address - Street 1:4265 OKEMOS RD
Practice Address - Street 2:SUITE E
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-3285
Practice Address - Country:US
Practice Address - Phone:517-349-6111
Practice Address - Fax:517-349-2843
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MID0119421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4050332Medicaid