Provider Demographics
NPI:1639505753
Name:KIRKPATRICK, STEPHEN LEE (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:LEE
Last Name:KIRKPATRICK
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 1:2952 LIMITED LN NW UNIT B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4546
Mailing Address - Country:US
Mailing Address - Phone:360-534-0053
Mailing Address - Fax:360-534-0278
Practice Address - Street 1:2952 LIMITED LN NW UNIT B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4546
Practice Address - Country:US
Practice Address - Phone:360-534-0053
Practice Address - Fax:360-534-0278
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-20
Last Update Date:2013-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000052771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5017603Medicaid