Provider Demographics
NPI:1912404708
Name:KIKLIS CHRISTENSEN, ZOE (DDS)
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:KIKLIS CHRISTENSEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:GORHAM
Mailing Address - State:ME
Mailing Address - Zip Code:04038-1715
Mailing Address - Country:US
Mailing Address - Phone:914-216-3620
Mailing Address - Fax:
Practice Address - Street 1:77 SOUTH ST
Practice Address - Street 2:
Practice Address - City:GORHAM
Practice Address - State:ME
Practice Address - Zip Code:04038-1715
Practice Address - Country:US
Practice Address - Phone:207-222-0522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1042241223G0001X
390200000X
ME49461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME1912404708Medicaid