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General NPI Number Information
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NPI Number | 1700348653
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Entity Type | Individual
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Provider Name | JUSTIN JAMES KIRKWOOD DMD
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Gender | Male
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Dates
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Enumeration Date | 04/01/2019
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Last Update Date | 12/05/2024
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Provider Practice Location Address
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Address Line | 100 GREAT OAKS BLVD STE 112
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City | ALBANY
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State | NY
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Zip | 12203-7924
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Country | US
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Telephone | 186-826-4005
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Fax | 518-682-6402
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Provider Business Mailing Address
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Address Line | 200 ALBERT SABIN WAY, ML 0461 HOLMES HOSPITAL, OFFICE 2220
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City | CINCINNATI
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State | OH
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Zip | 45267
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Country | US
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Telephone | 513-584-2586
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Fax | 513-584-1125
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 064184
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License Number State | NY
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