Provider Demographics
NPI:1619090776
Name:KIRKLAND, MARK D (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:KIRKLAND
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 1:700 39TH AVE APT 403
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-3466
Mailing Address - Country:US
Mailing Address - Phone:415-751-7023
Mailing Address - Fax:
Practice Address - Street 1:100 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6147
Practice Address - Country:US
Practice Address - Phone:415-476-5608
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32106122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist