MEDICARE: MR. DENNIS EDWARD KIRKBY 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	1223G0001X	General Practice Dentistry	2901011319	MI

General Provider Information

NPI Number	:	1851371124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DENNIS EDWARD KIRKBY DDS

Provider Business Mailing Address
First Line	:	112 E MAIN ST
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712
Country	:	US
Telephone Number	:	231-582-6944
Fax Number	:	231-582-6978

Provider Business Practice Location Address
First Line	:	112 E MAIN ST
Second Line	:
City	:	BOYNE CITY
State	:	MI
Zip	:	49712
Country	:	US
Telephone Number	:	231-582-6944
Fax Number	:	231-582-6978

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

Provider Enumeration Date	:	01/20/2006
Last Update Date	:	07/08/2007

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