Provider Demographics
NPI:1760714281
Name:KIRKSEY, JENNIEFER MAY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIEFER
Middle Name:MAY
Last Name:KIRKSEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 BERYWOOD TRL NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37312-5251
Mailing Address - Country:US
Mailing Address - Phone:423-476-6258
Mailing Address - Fax:423-476-6494
Practice Address - Street 1:414 BERYWOOD TRL NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-5251
Practice Address - Country:US
Practice Address - Phone:423-476-6258
Practice Address - Fax:423-476-6494
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS-88561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice