Provider Demographics
NPI:1255015988
Name:BIRDE, KAYLA MANNION (DMD)
Entity type:Individual
Prefix:DR
First Name:KAYLA
Middle Name:MANNION
Last Name:BIRDE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 SCARBOROUGH DOWNS RD UNIT 329
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04074-6585
Mailing Address - Country:US
Mailing Address - Phone:732-725-2411
Mailing Address - Fax:
Practice Address - Street 1:440 NARRAGANSETT TRL
Practice Address - Street 2:
Practice Address - City:BUXTON
Practice Address - State:ME
Practice Address - Zip Code:04093-6505
Practice Address - Country:US
Practice Address - Phone:207-605-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN5059122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist