Provider Demographics
NPI:1346419322
Name:JAMES C KIRK, DDS/PA
Entity Type:Organization
Organization Name:JAMES C KIRK, DDS/PA
Other - Org Name:SPRING LAKE DENTAL CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:CLIFFORD
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-497-2969
Mailing Address - Street 1:203 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING LAKE
Mailing Address - State:NC
Mailing Address - Zip Code:28390-3902
Mailing Address - Country:US
Mailing Address - Phone:910-497-2969
Mailing Address - Fax:910-497-6505
Practice Address - Street 1:203 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRING LAKE
Practice Address - State:NC
Practice Address - Zip Code:28390-3902
Practice Address - Country:US
Practice Address - Phone:910-497-2969
Practice Address - Fax:910-497-6505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC60421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty