Provider Demographics
NPI:1013007806
Name:KIRKSEY, HAROLD EDWARD (DMD)
Entity Type:Individual
Prefix:
First Name:HAROLD
Middle Name:EDWARD
Last Name:KIRKSEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 W SWANN AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4048
Mailing Address - Country:US
Mailing Address - Phone:813-872-6500
Mailing Address - Fax:
Practice Address - Street 1:2511 W SWANN AVE STE 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4048
Practice Address - Country:US
Practice Address - Phone:813-872-6500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 158351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice