Provider Demographics
NPI:1083684831
Name:SHIRK, LAMONT A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAMONT
Middle Name:A
Last Name:SHIRK
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 1:205 S KANSAS AVE
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:KS
Mailing Address - Zip Code:67654-2131
Mailing Address - Country:US
Mailing Address - Phone:785-877-2821
Mailing Address - Fax:
Practice Address - Street 1:205 S KANSAS AVE
Practice Address - Street 2:
Practice Address - City:NORTON
Practice Address - State:KS
Practice Address - Zip Code:67654-2131
Practice Address - Country:US
Practice Address - Phone:785-877-2821
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice