Provider Demographics
NPI:1609059997
Name:KIRK, LOREN BRUCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LOREN
Middle Name:BRUCE
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 1:125 CONOVER LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9063
Mailing Address - Country:US
Mailing Address - Phone:805-434-1567
Mailing Address - Fax:
Practice Address - Street 1:125 CONOVER LN
Practice Address - Street 2:
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9063
Practice Address - Country:US
Practice Address - Phone:805-434-1567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA033053122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist