Provider Demographics
NPI:1689692899
Name:KIRKLAND, JASON KENT (DDS)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:KENT
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 1:1640 E RIVER RD
Mailing Address - Street 2:#112
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-7644
Mailing Address - Country:US
Mailing Address - Phone:520-299-4470
Mailing Address - Fax:520-299-4475
Practice Address - Street 1:1640 E RIVER RD
Practice Address - Street 2:#112
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85718-7644
Practice Address - Country:US
Practice Address - Phone:520-299-4470
Practice Address - Fax:520-299-4475
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD52251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice