Provider Demographics
NPI:1235238619
Name:KIRK, MICHAEL KENT (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:KENT
Last Name:KIRK
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 1:1057 NW GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118
Mailing Address - Country:US
Mailing Address - Phone:405-848-3719
Mailing Address - Fax:405-848-9741
Practice Address - Street 1:1057 NW GRAND BLVD
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118
Practice Address - Country:US
Practice Address - Phone:405-848-3719
Practice Address - Fax:405-848-9741
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist