Provider Demographics
NPI:1316956402
Name:DAVIES, KIRK ROBERT (DDS, MS)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:ROBERT
Last Name:DAVIES
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2117 CORPORATE DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53189-7994
Mailing Address - Country:US
Mailing Address - Phone:262-542-9151
Mailing Address - Fax:262-542-5010
Practice Address - Street 1:2117 CORPORATE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53189-7994
Practice Address - Country:US
Practice Address - Phone:262-542-9151
Practice Address - Fax:262-542-5010
Is Sole Proprietor?:No
Enumeration Date:2006-08-06
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5033-0151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics