Provider Demographics
NPI:1285340380
Name:JUSTIN SHIRK DDS LLC
Entity type:Organization
Organization Name:JUSTIN SHIRK DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIRK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:785-871-0692
Mailing Address - Street 1:1725 E PINE GROVE CT
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:KS
Mailing Address - Zip Code:67037-3950
Mailing Address - Country:US
Mailing Address - Phone:785-871-0692
Mailing Address - Fax:
Practice Address - Street 1:4444 S 86TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9253
Practice Address - Country:US
Practice Address - Phone:785-871-0692
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental