Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 16490 | NJ |
NPI | 1003900937 |
---|---|
Provider Name | Laurence William Kielt |
First Address | Cherry Hill, NJ 08054-2579 |
Second Address | Cherry Hill, NJ 08054-2579 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 08/07/2007 |