Provider Demographics
NPI:1548444995
Name:NATHAN R. KITCHEN, D.M.D., PC
Entity type:Organization
Organization Name:NATHAN R. KITCHEN, D.M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:KITCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-830-8946
Mailing Address - Street 1:1259 N POWER RD
Mailing Address - Street 2:#1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4909
Mailing Address - Country:US
Mailing Address - Phone:480-830-8946
Mailing Address - Fax:480-854-3869
Practice Address - Street 1:1259 N POWER RD
Practice Address - Street 2:#1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4909
Practice Address - Country:US
Practice Address - Phone:480-830-8946
Practice Address - Fax:480-854-3869
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ48801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty