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General NPI Number Information
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NPI Number | 1225437981
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Entity Type | Organization
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Legal Business Name | KIRK ROUND DMD PC
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Dates
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Enumeration Date | 08/19/2014
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Last Update Date | 08/19/2014
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Provider Practice Location Address
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Address Line | 338 BANTAM ROAD
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City | LITCHFIELD
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State | CT
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Zip | 06759
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Country | US
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Telephone | 860-567-0811
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1333
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City | LITCHFIELD
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State | CT
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Zip | 06759
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Country | US
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Telephone | 860-567-0811
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KIRK ROUND
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Credential |
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Telephone | 860-482-3585
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 011130
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License Number State | CT
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