Provider Demographics
NPI:1639377211
Name:KIRKPATRICK, RENEE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:RENEE
Middle Name:ELIZABETH
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2150
Mailing Address - Country:US
Mailing Address - Phone:810-629-9432
Mailing Address - Fax:
Practice Address - Street 1:111 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430-2150
Practice Address - Country:US
Practice Address - Phone:810-629-9432
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2015-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI290109667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist