Provider Demographics
NPI:1588803472
Name:KIRTLAND, WILLIAM D (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:D
Last Name:KIRTLAND
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 1:4236 ALBANY POST ROAD
Mailing Address - Street 2:SUITE K
Mailing Address - City:HYDE PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12538
Mailing Address - Country:US
Mailing Address - Phone:845-229-5101
Mailing Address - Fax:845-229-7506
Practice Address - Street 1:4236 ALBANY POST RD
Practice Address - Street 2:SUITE K
Practice Address - City:HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:12538
Practice Address - Country:US
Practice Address - Phone:845-229-5101
Practice Address - Fax:845-229-7506
Is Sole Proprietor?:No
Enumeration Date:2009-02-17
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0305141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice