Provider Demographics
NPI:1902989619
Name:BIRCHEN, KIM A (DDS)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:A
Last Name:BIRCHEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 S UNION AVE
Mailing Address - Street 2:
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-3422
Mailing Address - Country:US
Mailing Address - Phone:410-939-1780
Mailing Address - Fax:410-939-1748
Practice Address - Street 1:620 S UNION AVE
Practice Address - Street 2:
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-3422
Practice Address - Country:US
Practice Address - Phone:410-939-1780
Practice Address - Fax:410-939-1748
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10199122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist