Provider Demographics
NPI:1265678908
Name:KIRK, CHRISTINE NOEL (DDS, CAGS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:NOEL
Last Name:KIRK
Suffix:
Gender:F
Credentials:DDS, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 BEACON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-4808
Mailing Address - Country:US
Mailing Address - Phone:617-731-3364
Mailing Address - Fax:617-734-1553
Practice Address - Street 1:1425 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4808
Practice Address - Country:US
Practice Address - Phone:617-731-3364
Practice Address - Fax:617-734-1553
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21036122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist