Provider Demographics
NPI:1942972997
Name:KIRTON, DAWAYNE D JR
Entity Type:Individual
Prefix:
First Name:DAWAYNE
Middle Name:D
Last Name:KIRTON
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 QUINCY SHORE DR
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-2019
Mailing Address - Country:US
Mailing Address - Phone:781-733-7704
Mailing Address - Fax:
Practice Address - Street 1:509 QUINCY SHORE DR
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171-2019
Practice Address - Country:US
Practice Address - Phone:781-733-7704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer