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General NPI Number Information
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NPI Number | 1275535320
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Entity Type | Individual
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Provider Name | KELLY ANN KIRTLAND DDS,MS,MA
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Gender | Female
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Dates
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Enumeration Date | 06/01/2005
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Last Update Date | 05/26/2021
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Provider Practice Location Address
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Address Line | 716 STEVENS AVE
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City | PORTLAND
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State | ME
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Zip | 04103-2693
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Country | US
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Telephone | 207-221-4634
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Fax |
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Provider Business Mailing Address
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Address Line | 716 STEVENS AVE
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City | PORTLAND
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State | ME
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Zip | 04103-2693
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Country | US
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Telephone | 207-221-4634
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | DEN4848
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License Number State | ME
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