MEDICARE: DR. ANNA KIHM MCILWAIN DDS

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	11799	NC

General Provider Information

NPI Number	:	1316561640
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANNA KIHM MCILWAIN DDS

Provider Business Mailing Address
First Line	:	2221 CHARLOTTE ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-2027
Country	:	US
Telephone Number	:	919-880-4017
Fax Number	:

Provider Business Practice Location Address
First Line	:	2221 CHARLOTTE ST
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27705-2027
Country	:	US
Telephone Number	:	919-880-4017
Fax Number	:

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

Provider Enumeration Date	:	06/02/2020
Last Update Date	:	06/02/2020

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