MEDICARE: DR. CHRISTOPHER TOM KIRKWOOD DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	12012684A	IN

General Provider Information

NPI Number	:	1801323886
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER TOM KIRKWOOD DDS

Provider Business Mailing Address
First Line	:	808 E MULBERRY ST
Second Line	:
City	:	FORT BRANCH
State	:	IN
Zip	:	47648-1665
Country	:	US
Telephone Number	:	812-753-4457
Fax Number	:	812-753-4458

Provider Business Practice Location Address
First Line	:	808 E MULBERRY ST
Second Line	:
City	:	FORT BRANCH
State	:	IN
Zip	:	47648-1665
Country	:	US
Telephone Number	:	812-753-4457
Fax Number	:	812-753-4458

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2017
Last Update Date	:	07/21/2022

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