Provider Demographics
NPI:1316153794
Name:APOCOTOS-KIRK, JENNIFER (RDH,MA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:APOCOTOS-KIRK
Suffix:
Gender:F
Credentials:RDH,MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 AVIATION BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95403-1074
Mailing Address - Country:US
Mailing Address - Phone:707-575-3105
Mailing Address - Fax:
Practice Address - Street 1:418 AVIATION BLVD
Practice Address - Street 2:SUTIE A
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-1074
Practice Address - Country:US
Practice Address - Phone:707-575-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16784124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist