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General NPI Number Information
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NPI Number | 1558322321
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Entity Type | Individual
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Provider Name | RUSSELL KEITH KIRK D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2006
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Last Update Date | 05/03/2011
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Provider Practice Location Address
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Address Line | 1409 W BADDOUR PKWY SUITE #F
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City | LEBANON
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State | TN
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Zip | 37087-2513
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Country | US
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Telephone | 615-453-7800
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Fax | 615-453-7858
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Provider Business Mailing Address
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Address Line | 5594 FRANKLIN RD
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City | LEBANON
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State | TN
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Zip | 37090-8101
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Country | US
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Telephone | 615-453-7800
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Fax | 615-453-7858
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 7103
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License Number State | TN
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