Provider Demographics
NPI:1386058493
Name:MCELHENY, KIRK DANIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:DANIEL
Last Name:MCELHENY
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 1:3601 N SAINT PETERS PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7303
Mailing Address - Country:US
Mailing Address - Phone:636-441-4415
Mailing Address - Fax:636-441-1704
Practice Address - Street 1:3601 N SAINT PETERS PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7303
Practice Address - Country:US
Practice Address - Phone:636-441-4415
Practice Address - Fax:636-441-1704
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2014-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20140166471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice