Provider Demographics
NPI:1144600651
Name:KIEFER PERIODONTICS AND DENTAL IMPLANTS PC
Entity type:Organization
Organization Name:KIEFER PERIODONTICS AND DENTAL IMPLANTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:P
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:781-551-8787
Mailing Address - Street 1:89 ACCESS RD
Mailing Address - Street 2:SUITE 30
Mailing Address - City:NORWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02062-5229
Mailing Address - Country:US
Mailing Address - Phone:781-551-8787
Mailing Address - Fax:781-551-0438
Practice Address - Street 1:89 ACCESS RD
Practice Address - Street 2:SUITE 30
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-5229
Practice Address - Country:US
Practice Address - Phone:781-551-8787
Practice Address - Fax:781-551-0438
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN220261223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty