Provider Demographics
NPI:1427619154
Name:KIRKLAND, BRIAN T (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:T
Last Name:KIRKLAND
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1975 MIDDLETON ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4695
Mailing Address - Country:US
Mailing Address - Phone:610-806-3068
Mailing Address - Fax:
Practice Address - Street 1:1380 PARK ST
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29115-4880
Practice Address - Country:US
Practice Address - Phone:803-536-9300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-24
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC94001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice