Provider Demographics
NPI:1154499838
Name:KIRK, ERIC DANIEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DANIEL
Last Name:KIRK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:DANIEL
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS, INC
Mailing Address - Street 1:1505 SHEPARD DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-7020
Mailing Address - Country:US
Mailing Address - Phone:805-925-1425
Mailing Address - Fax:805-925-6625
Practice Address - Street 1:1505 SHEPARD DR
Practice Address - Street 2:SUITE 202
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-7020
Practice Address - Country:US
Practice Address - Phone:805-925-1425
Practice Address - Fax:805-925-6625
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA345081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice