Provider Demographics
NPI:1477786705
Name:CHADBOURNE, KYRA (DDS)
Entity Type:Individual
Prefix:DR
First Name:KYRA
Middle Name:
Last Name:CHADBOURNE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 LEIGHTON RD
Mailing Address - Street 2:
Mailing Address - City:FALMOUTH
Mailing Address - State:ME
Mailing Address - Zip Code:04105-2225
Mailing Address - Country:US
Mailing Address - Phone:207-878-8600
Mailing Address - Fax:207-221-1955
Practice Address - Street 1:78 LEIGHTON RD
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-2225
Practice Address - Country:US
Practice Address - Phone:207-878-8600
Practice Address - Fax:207-221-1955
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-03
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0000122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist