MEDICARE: KIRSTIE NINAN

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	1223G0001X	General Practice Dentistry	101948	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	122300000X	Dentist	16730	MD
4	122300000X	Dentist	25626	FL

General Provider Information

NPI Number	:	1275987190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIRSTIE NINAN

Provider Business Mailing Address
First Line	:	901 BRICK MANOR CIR
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20905-3818
Country	:	US
Telephone Number	:	540-623-6415
Fax Number	:

Provider Business Practice Location Address
First Line	:	3130 OLNEY SANDY SPRING RD
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-1408
Country	:	US
Telephone Number	:	240-665-5485
Fax Number	:

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

Provider Enumeration Date	:	04/17/2016
Last Update Date	:	03/21/2026

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