Provider Demographics
NPI:1750692190
Name:KIRKLAND, ALEXIS NICOLE (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:NICOLE
Last Name:KIRKLAND
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:
Other - Last Name:DAYSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6828 RACE TRACK RD STE B
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3042
Mailing Address - Country:US
Mailing Address - Phone:202-500-3220
Mailing Address - Fax:
Practice Address - Street 1:6828 RACE TRACK RD STE B
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20715-3042
Practice Address - Country:US
Practice Address - Phone:202-500-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-30
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN1000905122300000X
MD145321223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics