Provider Demographics
NPI:1124184817
Name:ZIRKER, JED KARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JED
Middle Name:KARL
Last Name:ZIRKER
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 1:1801 S AMMON RD
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6860
Mailing Address - Country:US
Mailing Address - Phone:208-528-7665
Mailing Address - Fax:208-522-9556
Practice Address - Street 1:1801 S AMMON RD
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6860
Practice Address - Country:US
Practice Address - Phone:208-528-7665
Practice Address - Fax:208-522-9556
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD37081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice