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General NPI Number Information
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NPI Number | 1831361013
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Entity Type | Organization
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Legal Business Name | RUSSELL K KIRK, DDS, PC
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Dates
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Enumeration Date | 03/28/2008
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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 WEST BADDOUR PARKWAY SUITE F
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City | LEBANON
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State | TN
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Zip | 37087
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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 | 1409 WEST BADDOUR PARKWAY SUITE F
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City | LEBANON
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State | TN
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Zip | 37087
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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 | PRESIDENT
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Name | DR. RUSSELL KEITH KIRK
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Credential | DDS
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Telephone | 615-453-7800
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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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