Provider Demographics
NPI:1881730844
Name:DRS MARTIN & KIRK PLLC
Entity type:Organization
Organization Name:DRS MARTIN & KIRK PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-201-8500
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-0581
Mailing Address - Country:US
Mailing Address - Phone:304-201-8500
Mailing Address - Fax:304-201-8505
Practice Address - Street 1:3659 TEAYS VALLEY ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:HURRICANE
Practice Address - State:WV
Practice Address - Zip Code:25526-9701
Practice Address - Country:US
Practice Address - Phone:304-201-8500
Practice Address - Fax:304-201-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV35681223P0221X
WVWV32641223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002523Medicaid