Basic Information
| Provider Information | |||||||||
| NPI: | 1396022604 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KIRT | ||||||||
| FirstName: | JONATHAN | ||||||||
| MiddleName: | MARTIN | ||||||||
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| Mailing Information | |||||||||
| Address1: | G3375 S SAGINAW ST | ||||||||
| Address2: | |||||||||
| City: | BURTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485291277 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8107436830 | ||||||||
| FaxNumber: | 8107437102 | ||||||||
| Practice Location | |||||||||
| Address1: | 225 E 5TH ST | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FLINT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 485021641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8104064246 | ||||||||
| FaxNumber: | 8104246029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/15/2011 | ||||||||
| LastUpdateDate: | 11/15/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 2902015775 | MI | Y | Dental Providers | Dental Hygienist |
No ID Information.