Provider Demographics
NPI:1639185960
Name:ALLRED, KIRK H (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:KIRK
Middle Name:H
Last Name:ALLRED
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 HARRISON BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-2081
Mailing Address - Country:US
Mailing Address - Phone:801-393-6200
Mailing Address - Fax:801-394-3303
Practice Address - Street 1:3550 HARRISON BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-2081
Practice Address - Country:US
Practice Address - Phone:801-393-6200
Practice Address - Fax:801-394-3303
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT141076-99211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT615985OtherUNITED CONCORDIA PROVIDER