Provider Demographics
NPI:1316095839
Name:STEPHEN L. KIRKPATRICK, DDS, PLLC
Entity type:Organization
Organization Name:STEPHEN L. KIRKPATRICK, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER OF PLLC
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:360-534-0053
Mailing Address - Street 1:2952 LIMITED LN NW UNIT B
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-4546
Mailing Address - Country:US
Mailing Address - Phone:360-534-0053
Mailing Address - Fax:360-534-0278
Practice Address - Street 1:2952 LIMITED LN NW UNIT B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-4546
Practice Address - Country:US
Practice Address - Phone:360-534-0053
Practice Address - Fax:360-534-0278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000052771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5017603Medicaid