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NPI Code Detail

MEDICARE: DR. KELLY ANN KIRTLAND DDS,MS,MA

MEDICARE: DR. KELLY ANN KIRTLAND DDS,MS,MA
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
11223P0221XPediatric DentistryDEN4848ME

General Provider Information

NPI Number : 1275535320
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KELLY ANN KIRTLAND DDS,MS,MA
Provider Business Mailing Address
First Line : 716 STEVENS AVE
Second Line :
City : PORTLAND
State : ME
Zip : 04103-2693
Country : US
Telephone Number : 207-221-4634
Fax Number :
Provider Business Practice Location Address
First Line : 716 STEVENS AVE
Second Line :
City : PORTLAND
State : ME
Zip : 04103-2693
Country : US
Telephone Number : 207-221-4634
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2005
Last Update Date : 05/26/2021

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