Provider Demographics
NPI:1780607135
Name:KAIGLER, TIMOTHY JOSEPH (DMD,MAGD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:KAIGLER
Suffix:
Gender:M
Credentials:DMD,MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 WESTRIDGE PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-3048
Mailing Address - Country:US
Mailing Address - Phone:770-898-3192
Mailing Address - Fax:770-898-3747
Practice Address - Street 1:70 WESTRIDGE PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3048
Practice Address - Country:US
Practice Address - Phone:770-898-3192
Practice Address - Fax:770-898-3747
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2008-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA91721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice