Provider Demographics
NPI:1063465748
Name:BROWN, KIRK DANIELS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:DANIELS
Last Name:BROWN
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 1:792 DEER PATH
Mailing Address - Street 2:
Mailing Address - City:COPPER CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:75077-4800
Mailing Address - Country:US
Mailing Address - Phone:940-367-3148
Mailing Address - Fax:
Practice Address - Street 1:3000 VILLAGE PKWY
Practice Address - Street 2:SUITE 420
Practice Address - City:HIGHLAND VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:75077-3270
Practice Address - Country:US
Practice Address - Phone:972-317-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-8796122300000X
KY8595122300000X
TX257561223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No122300000XDental ProvidersDentist