Provider Demographics
NPI:1093803439
Name:KIRKLAND, W. KEITH (DMD)
Entity Type:Individual
Prefix:DR
First Name:W. KEITH
Middle Name:
Last Name:KIRKLAND
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 1:2170 SAVANNAH HWY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29414-5311
Mailing Address - Country:US
Mailing Address - Phone:843-571-0117
Mailing Address - Fax:843-571-0952
Practice Address - Street 1:2170 SAVANNAH HWY
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5311
Practice Address - Country:US
Practice Address - Phone:843-571-0117
Practice Address - Fax:843-571-0952
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ28068Medicaid