Provider Demographics
NPI:1427150119
Name:PIRK, FREDERICK WALTER (DDS MS)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:WALTER
Last Name:PIRK
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 1:7211 N MESA ST
Mailing Address - Street 2:STE 1W
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-3611
Mailing Address - Country:US
Mailing Address - Phone:915-581-7839
Mailing Address - Fax:915-585-1225
Practice Address - Street 1:7211 N MESA ST
Practice Address - Street 2:STE 1W
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-3611
Practice Address - Country:US
Practice Address - Phone:915-581-7839
Practice Address - Fax:915-585-1225
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX112851223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics