Provider Demographics
NPI:1558373498
Name:GAMMELL, KIRK (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRK
Middle Name:
Last Name:GAMMELL
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 1:7320 S YALE AVE STE B
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7034
Mailing Address - Country:US
Mailing Address - Phone:918-749-7206
Mailing Address - Fax:
Practice Address - Street 1:7320 S YALE AVE STE B
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7034
Practice Address - Country:US
Practice Address - Phone:918-496-2499
Practice Address - Fax:918-494-0833
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK45981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice