Provider Demographics
NPI:1265902258
Name:MASSIE, KIRA RAYN (RDH)
Entity type:Individual
Prefix:MISS
First Name:KIRA
Middle Name:RAYN
Last Name:MASSIE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30685 COUNTY ROAD 581
Mailing Address - Street 2:
Mailing Address - City:ISHPEMING
Mailing Address - State:MI
Mailing Address - Zip Code:49849-9247
Mailing Address - Country:US
Mailing Address - Phone:906-236-5264
Mailing Address - Fax:
Practice Address - Street 1:301 EXPLORER ST
Practice Address - Street 2:
Practice Address - City:GWINN
Practice Address - State:MI
Practice Address - Zip Code:49841-2813
Practice Address - Country:US
Practice Address - Phone:906-346-9275
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-03
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902018495124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist