Kirtland Family Dentistry LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

KIRTLAND FAMILY DENTISTRY LLC

Practice address

8521 Central Ave NE Ste 101
Albuquerque, NM 87108-2501

Phone

(505) 266-5881

Fax

(505) 266-7172

NPI assigned

Dec 16, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Faith Gaskins

Title

Director of Credentialing

Phone

(972) 869-3789

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1544918400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1544918400000",
    "number": "1124599253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2403 LACY LN",
            "city": "CARROLLTON",
            "state": "TX",
            "postal_code": "750066514",
            "telephone_number": "972-869-3789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8521 CENTRAL AVE NE STE 101",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871082501",
            "telephone_number": "505-266-5881",
            "fax_number": "505-266-7172"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRTLAND FAMILY DENTISTRY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-12-16",
        "last_updated": "2018-12-16",
        "status": "A",
        "authorized_official_last_name": "GASKINS",
        "authorized_official_first_name": "FAITH",
        "authorized_official_title_or_position": "DIRECTOR OF CREDENTIALING",
        "authorized_official_telephone_number": "972-869-3789"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael Anthony Kirolos, PHARM.D
• Megan Kirouac, PHD
• Laura Kirsch
• Cynthia Ann Kirschenman, RN
• Courtney Kirschman
• Nicole Marie Kiselicka-Sickmiller, BCABA
• Angela M Kisner, DOM, FNP-CB, BSN-RN
• Mallory A Kisner, MA
• Adam Kiss, SW
• Anna Kistin, MD

• General Practice Dentistry in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• General Practice Dentistry in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.