Provider Demographics
NPI:1750419370
Name:DOUGLAS L. KIROL, DDS, PA
Entity type:Organization
Organization Name:DOUGLAS L. KIROL, DDS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIROL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:803-328-2411
Mailing Address - Street 1:219 OAKLAND AVE.
Mailing Address - Street 2:
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29730
Mailing Address - Country:US
Mailing Address - Phone:803-328-2411
Mailing Address - Fax:803-328-5776
Practice Address - Street 1:219 OAKLAND AVE.
Practice Address - Street 2:
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29730
Practice Address - Country:US
Practice Address - Phone:803-328-2411
Practice Address - Fax:803-328-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC993648Medicaid