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General NPI Number Information
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NPI Number | 1265972939
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Entity Type | Organization
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Legal Business Name | JOSHUA KIRK, DMD, PLLC
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Dates
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Enumeration Date | 03/01/2017
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Last Update Date | 03/01/2017
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Provider Practice Location Address
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Address Line | 708 E MOUNTAIN VIEW AVE
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City | ELLENSBURG
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State | WA
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Zip | 98926-3862
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Country | US
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Telephone | 509-962-2755
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Fax |
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Provider Business Mailing Address
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Address Line | 708 E MOUNTAIN VIEW AVE
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City | ELLENSBURG
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State | WA
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Zip | 98926-3862
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Country | US
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Telephone | 509-962-2755
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JOSHUA KIRK
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Credential | D.M.D.
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Telephone | 509-859-3632
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DE 60543842
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License Number State | WA
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