Provider Demographics
NPI:1033255690
Name:KIRKLAND, KEVIN THOMAS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:THOMAS
Last Name:KIRKLAND
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46607 PINEHURST CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-8488
Mailing Address - Country:US
Mailing Address - Phone:734-254-9221
Mailing Address - Fax:
Practice Address - Street 1:3276 WEST RD
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2322
Practice Address - Country:US
Practice Address - Phone:734-676-4744
Practice Address - Fax:734-676-3641
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010177601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI726746OtherUNITED CONCORDIA
MAD177600OtherBLUE CROSS BLUE SHIELD MI