Provider Demographics
NPI:1710117304
Name:KIRK FUHRIMAN PLLC
Entity Type:Organization
Organization Name:KIRK FUHRIMAN PLLC
Other - Org Name:CHILDRENS DENTAL VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERI
Authorized Official - Middle Name:R
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:509-891-9011
Mailing Address - Street 1:420 N EVERGREEN RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99216-0973
Mailing Address - Country:US
Mailing Address - Phone:509-891-9011
Mailing Address - Fax:509-891-8999
Practice Address - Street 1:420 N EVERGREEN RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99216-0973
Practice Address - Country:US
Practice Address - Phone:509-891-9011
Practice Address - Fax:509-891-8999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-17
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010409122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2001636Medicaid
WADE00010409OtherWA STATE LICENSE
WA5055652Medicaid