Provider Demographics
NPI:1811910987
Name:JONES, KELLEN KIRSCH PROFESSIONAL CORP.
Entity type:Organization
Organization Name:JONES, KELLEN KIRSCH PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:M
Authorized Official - Last Name:KELLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-586-0270
Mailing Address - Street 1:24400 MUIRLANDS BLVD
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-3946
Mailing Address - Country:US
Mailing Address - Phone:949-586-0270
Mailing Address - Fax:949-859-8446
Practice Address - Street 1:24400 MUIRLANDS BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-3946
Practice Address - Country:US
Practice Address - Phone:949-586-0270
Practice Address - Fax:949-859-8446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD213751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty