Provider Demographics
NPI:1780993485
Name:KIGHT, ANTHONY CHARLES (DDS)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:CHARLES
Last Name:KIGHT
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 1:263 EAST HOSPITAL ROAD, BUILDING 322
Mailing Address - Street 2:
Mailing Address - City:FORT EISENHOWER
Mailing Address - State:GA
Mailing Address - Zip Code:30905-5650
Mailing Address - Country:US
Mailing Address - Phone:317-903-7092
Mailing Address - Fax:
Practice Address - Street 1:236 E HOSPITAL RD BLDG 322
Practice Address - Street 2:
Practice Address - City:FORT EISENHOWER
Practice Address - State:GA
Practice Address - Zip Code:30905-6011
Practice Address - Country:US
Practice Address - Phone:317-903-7092
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011518A122300000X, 1223P0700X
126900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
No126900000XDental ProvidersDental Laboratory Technician