1093726051 NPI number — DR. GEORGE GRAY KITCHENS JR. D.M.D., M.S.

Table of content: JAIME DAWN TRASSARE (NPI 1619842010)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093726051 NPI number — DR. GEORGE GRAY KITCHENS JR. D.M.D., M.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KITCHENS
Provider First Name:
GEORGE
Provider Middle Name:
GRAY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
D.M.D., M.S.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1093726051
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 LAFAY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREER
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29650-3784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-322-2469
Provider Business Mailing Address Fax Number:
864-322-2469

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
303 E HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ANDERSON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29621-4767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-225-6607
Provider Business Practice Location Address Fax Number:
864-225-6177
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223E0200X , with the licence number:  4091 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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