Provider Demographics
NPI:1083020283
Name:KIRSCHNER, RYAN MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MATTHEW
Last Name:KIRSCHNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 OVERLOOK RIDGE TER UNIT 208
Mailing Address - Street 2:
Mailing Address - City:REVERE
Mailing Address - State:MA
Mailing Address - Zip Code:02151-1192
Mailing Address - Country:US
Mailing Address - Phone:773-996-9541
Mailing Address - Fax:
Practice Address - Street 1:21 OVERLOOK RIDGE TER UNIT 208
Practice Address - Street 2:
Practice Address - City:REVERE
Practice Address - State:MA
Practice Address - Zip Code:02151-1192
Practice Address - Country:US
Practice Address - Phone:773-996-9541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-08
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADL12269122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist