Provider Demographics
NPI:1770140030
Name:M KENT KISER, DDS, LTD
Entity type:Organization
Organization Name:M KENT KISER, DDS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:KISER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:540-639-0111
Mailing Address - Street 1:1151 E MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-1761
Mailing Address - Country:US
Mailing Address - Phone:540-639-0111
Mailing Address - Fax:540-639-6111
Practice Address - Street 1:1151 E MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-1761
Practice Address - Country:US
Practice Address - Phone:540-639-0111
Practice Address - Fax:540-639-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-22
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty