MEDICARE: DR. BERNARD A KILCLINE DMD

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	1570	RI

General Provider Information

NPI Number	:	1033179585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERNARD A KILCLINE DMD

Provider Business Mailing Address
First Line	:	161 AIRPORT RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02889-1031
Country	:	US
Telephone Number	:	401-738-2193
Fax Number	:	401-732-5367

Provider Business Practice Location Address
First Line	:	161 AIRPORT RD
Second Line	:
City	:	WARWICK
State	:	RI
Zip	:	02889-1031
Country	:	US
Telephone Number	:	401-738-2193
Fax Number	:	401-732-5367

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

Provider Enumeration Date	:	03/27/2006
Last Update Date	:	07/08/2007

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