MEDICARE: DR. KIRBY STUART KJAR 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	1223E0200X	Endodontics	25135	TX
2	1223E0200X	Endodontics	5388076-9922	UT

General Provider Information

NPI Number	:	1538114095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRBY STUART KJAR DMD

Provider Business Mailing Address
First Line	:	2954 CARRINGTON ROAD
Second Line	:
City	:	FORT BLISS
State	:	TX
Zip	:	79920
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2954 CARRINGTON ROAD
Second Line	:
City	:	FORT BLISS
State	:	TX
Zip	:	79920
Country	:	US
Telephone Number	:	915-569-5505
Fax Number	:

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	03/22/2010

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