Provider Demographics
NPI:1568650471
Name:ERIC D KYRK DDS PC
Entity Type:Organization
Organization Name:ERIC D KYRK DDS PC
Other - Org Name:HARRAH FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:D
Authorized Official - Last Name:KYRK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-309-6013
Mailing Address - Street 1:PO 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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-05
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental