Provider Demographics
NPI:1790142701
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:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRK
Authorized Official - Middle Name:E
Authorized Official - Last Name:FUHRIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-863-9460
Mailing Address - Street 1:9302 N COLTON ST
Mailing Address - Street 2:SUITE #100
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1290
Mailing Address - Country:US
Mailing Address - Phone:509-863-9460
Mailing Address - Fax:509-868-0428
Practice Address - Street 1:9302 N COLTON ST
Practice Address - Street 2:SUITE #100
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1290
Practice Address - Country:US
Practice Address - Phone:509-863-9460
Practice Address - Fax:509-868-0428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
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