Provider Demographics
NPI:1760687792
Name:KIRK, ANN BERGSTRESSER (DDS)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:BERGSTRESSER
Last Name:KIRK
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 1:57 CODJER LN
Mailing Address - Street 2:
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-2302
Mailing Address - Country:US
Mailing Address - Phone:978-443-4348
Mailing Address - Fax:978-443-4355
Practice Address - Street 1:57 CODJER LN
Practice Address - Street 2:
Practice Address - City:SUDBURY
Practice Address - State:MA
Practice Address - Zip Code:01776-2302
Practice Address - Country:US
Practice Address - Phone:978-443-4348
Practice Address - Fax:978-443-4355
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA108541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice