Basic Information
| Provider Information | |||||||||
| NPI: | 1265902258 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MASSIE | ||||||||
| FirstName: | KIRA | ||||||||
| MiddleName: | RAYN | ||||||||
| NamePrefix: | MISS | ||||||||
| NameSuffix: | |||||||||
| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 30685 COUNTY ROAD 581 | ||||||||
| Address2: | |||||||||
| City: | ISHPEMING | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498499247 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9062365264 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 301 EXPLORER ST | ||||||||
| Address2: | |||||||||
| City: | GWINN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 498412813 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9063469275 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/03/2018 | ||||||||
| LastUpdateDate: | 12/03/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 2902018495 | MI | Y | Dental Providers | Dental Hygienist |
No ID Information.