Provider Demographics
NPI:1366510372
Name:KIRK, EDWARD F (DDS)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:F
Last Name:KIRK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 W WICKENBURG WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:WICKENBURG
Mailing Address - State:AZ
Mailing Address - Zip Code:85390-2262
Mailing Address - Country:US
Mailing Address - Phone:928-684-5475
Mailing Address - Fax:928-684-1145
Practice Address - Street 1:1175 W WICKENBURG WAY STE 1
Practice Address - Street 2:
Practice Address - City:WICKENBURG
Practice Address - State:AZ
Practice Address - Zip Code:85390-2262
Practice Address - Country:US
Practice Address - Phone:928-684-5475
Practice Address - Fax:928-684-1145
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD51311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice