Provider Demographics
NPI:1881102572
Name:KIEVIT DENTAL, PLLC
Entity type:Organization
Organization Name:KIEVIT DENTAL, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEVIT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-748-5256
Mailing Address - Street 1:901 FARMINGTON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1418
Mailing Address - Country:US
Mailing Address - Phone:860-232-4511
Mailing Address - Fax:
Practice Address - Street 1:901 FARMINGTON AVE STE 201
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1418
Practice Address - Country:US
Practice Address - Phone:860-232-4511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-16
Last Update Date:2018-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental