MEDICARE: HAROLD EDWARD KIRKSEY DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN 15835	FL

General Provider Information

NPI Number	:	1013007806
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HAROLD EDWARD KIRKSEY DMD

Provider Business Mailing Address
First Line	:	2511 W SWANN AVE STE 103
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4048
Country	:	US
Telephone Number	:	813-872-6500
Fax Number	:

Provider Business Practice Location Address
First Line	:	2511 W SWANN AVE STE 103
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-4048
Country	:	US
Telephone Number	:	813-872-6500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	07/08/2007

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