Provider Demographics
NPI:1588235733
Name:KIRK, MATTHEW-JOSEPH O'HOLLEARN (DDS)
Entity Type:Individual
Prefix:
First Name:MATTHEW-JOSEPH
Middle Name:O'HOLLEARN
Last Name:KIRK
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 1:1108 7TH AVE APT 531
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4794
Mailing Address - Country:US
Mailing Address - Phone:720-238-5151
Mailing Address - Fax:
Practice Address - Street 1:4913 RUFE SNOW DR
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7856
Practice Address - Country:US
Practice Address - Phone:817-656-2945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-08
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice