Provider Demographics
NPI:1508048224
Name:KIRKLAND DDS INC
Entity Type:Organization
Organization Name:KIRKLAND DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:ZOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:RDHAP
Authorized Official - Phone:800-719-6107
Mailing Address - Street 1:26250 INDUSTRIAL BLVD STE 24
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2922
Mailing Address - Country:US
Mailing Address - Phone:800-719-6107
Mailing Address - Fax:
Practice Address - Street 1:24301 SOUTHLAND DR STE 409F
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-1551
Practice Address - Country:US
Practice Address - Phone:800-719-6107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty