MEDICARE: DR. KENNETH DONALD KIRKHAM DDS

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	122300000X	Dentist	15427	TX
2	1223G0001X	General Practice Dentistry	15427	TX

General Provider Information

NPI Number	:	1205947827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH DONALD KIRKHAM DDS

Provider Business Mailing Address
First Line	:	6400 SPOONWOOD LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2063
Country	:	US
Telephone Number	:	817-306-7474
Fax Number	:	817-306-0942

Provider Business Practice Location Address
First Line	:	6400 SPOONWOOD LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-2063
Country	:	US
Telephone Number	:	817-306-7474
Fax Number	:	817-306-0942

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	09/11/2025

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