Provider Demographics
NPI:1538263249
Name:KALLIAL, JOSEPH THOMAS (DDS)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:THOMAS
Last Name:KALLIAL
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 1:5960 HOWDERSHELL RD STE 202 HAZELWOOD MO 63042-4100
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HAZLEWOOD
Mailing Address - State:MO
Mailing Address - Zip Code:63042-4100
Mailing Address - Country:US
Mailing Address - Phone:314-731-5155
Mailing Address - Fax:314-731-2321
Practice Address - Street 1:5960 HOWDERSHELL RD
Practice Address - Street 2:SUITE 202
Practice Address - City:HAZELWOOD
Practice Address - State:MO
Practice Address - Zip Code:63042-4100
Practice Address - Country:US
Practice Address - Phone:314-731-5155
Practice Address - Fax:314-731-2321
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0106901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice