Provider Demographics
NPI:1467583245
Name:KYRK, ERIC D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:KYRK
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:P.O. BOX 1137
Mailing Address - Street 2:
Mailing Address - City:HARRAH
Mailing Address - State:OK
Mailing Address - Zip Code:73045
Mailing Address - Country:US
Mailing Address - Phone:405-309-6013
Mailing Address - Fax:405-309-6031
Practice Address - Street 1:2405 CAPPELLA BLVD.
Practice Address - Street 2:
Practice Address - City:HARRAH
Practice Address - State:OK
Practice Address - Zip Code:73045
Practice Address - Country:US
Practice Address - Phone:405-309-6013
Practice Address - Fax:405-309-6031
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK57901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice