Provider Demographics
NPI:1093867962
Name:KIRK A. TURNER, DDS, PA
Entity Type:Organization
Organization Name:KIRK A. TURNER, DDS, PA
Other - Org Name:CLEMMONS FAMILY DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-766-9111
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:6301 STADIUM DRIVE
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-0706
Mailing Address - Country:US
Mailing Address - Phone:336-766-9111
Mailing Address - Fax:336-766-3941
Practice Address - Street 1:6301 STADIUM DR
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8766
Practice Address - Country:US
Practice Address - Phone:336-766-9111
Practice Address - Fax:336-766-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2009-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998649Medicaid