Provider Demographics
NPI:1508960006
Name:KIRKPATRICK, STEVEN BRUCE (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRUCE
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 14TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-3016
Mailing Address - Country:US
Mailing Address - Phone:360-425-8140
Mailing Address - Fax:360-425-8145
Practice Address - Street 1:1105 14TH AVENUE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-3016
Practice Address - Country:US
Practice Address - Phone:360-425-8140
Practice Address - Fax:360-425-8145
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00005719122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5003595Medicaid