Provider Demographics
NPI:1134732217
Name:WARD, KIRK LYNDELL II
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:LYNDELL
Last Name:WARD
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 FLANNERS CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-8263
Mailing Address - Country:US
Mailing Address - Phone:713-397-7971
Mailing Address - Fax:
Practice Address - Street 1:12661 W LAKE HOUSTON PKWY STE G
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77044-1454
Practice Address - Country:US
Practice Address - Phone:281-372-0216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX365971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice