1245537125 NPI number — KALNIZ CHOKSEY ENTERPRISES, LLC

Table of content: (NPI 1245537125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245537125 NPI number — KALNIZ CHOKSEY ENTERPRISES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KALNIZ CHOKSEY ENTERPRISES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CORNER DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245537125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4210 W SYLVANIA AVE STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOLEDO
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43623-4501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-724-1758
Provider Business Mailing Address Fax Number:
888-241-1863

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4210 W SYLVANIA AVE STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOLEDO
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43623-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-724-1758
Provider Business Practice Location Address Fax Number:
888-241-1863
Provider Enumeration Date:
02/11/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KALNIZ
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
B
Authorized Official Title or Position:
CO-OWNER
Authorized Official Telephone Number:
419-724-1758

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  30020857 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1223G0001X , with the licence number: 30022027 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4210 . This is a "ADDRESS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".