Provider Demographics
NPI:1528553914
Name:VERSPOOR, KIRSTIN LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRSTIN
Middle Name:LYNN
Last Name:VERSPOOR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E MAIN ST STE D
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:44904-1366
Mailing Address - Country:US
Mailing Address - Phone:419-884-0011
Mailing Address - Fax:419-884-0016
Practice Address - Street 1:201 E MAIN ST STE D
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:44904-1366
Practice Address - Country:US
Practice Address - Phone:419-884-0011
Practice Address - Fax:419-884-0016
Is Sole Proprietor?:No
Enumeration Date:2018-06-27
Last Update Date:2018-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025503122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist