Provider Demographics
NPI:1831361013
Name:RUSSELL K KIRK, DDS, PC
Entity type:Organization
Organization Name:RUSSELL K KIRK, DDS, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-453-7800
Mailing Address - Street 1:1409 WEST BADDOUR PARKWAY
Mailing Address - Street 2:SUITE F
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087
Mailing Address - Country:US
Mailing Address - Phone:615-453-7800
Mailing Address - Fax:615-453-7858
Practice Address - Street 1:1409 WEST BADDOUR PARKWAY
Practice Address - Street 2:SUITE F
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087
Practice Address - Country:US
Practice Address - Phone:615-453-7800
Practice Address - Fax:615-453-7858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN71031223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty