Healthcare Provider Details

I. General information

NPI: 1477728764
Provider Name (Legal Business Name): WILLIAM S. KIRK JR DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 05/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S COLLEGE ST SUITE 1100
CHARLOTTE NC
28202-1825
US

IV. Provider business mailing address

600 S COLLEGE ST SUITE 1100
CHARLOTTE NC
28202-1825
US

V. Phone/Fax

Practice location:
  • Phone: 704-332-3701
  • Fax: 704-335-1835
Mailing address:
  • Phone: 704-332-3701
  • Fax: 704-335-1835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number4501
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number4501
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1223X0008X
TaxonomyOral and Maxillofacial Radiology Dentistry
License Number4501
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4501
License Number StateNC

VIII. Authorized Official

Name: DR. WILLIAM S KIRK JR.
Title or Position: OWNER
Credential: DDS
Phone: 704-332-3701