MEDICARE: KIRK DENTAL ASSOCIATES

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	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1548257751
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIRK DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	57 CODJER LN
Second Line	:
City	:	SUDBURY
State	:	MA
Zip	:	01776
Country	:	US
Telephone Number	:	978-443-4348
Fax Number	:	978-443-4355

Provider Business Practice Location Address
First Line	:	57 CODJER LN
Second Line	:
City	:	SUDBURY
State	:	MA
Zip	:	01776
Country	:	US
Telephone Number	:	978-443-4348
Fax Number	:	978-443-4355

Authorized Official
Title or Position	:	OWNER/DENTIST
Name	:	DR. DAVID QUENTIN KIRK JR.
Credential	:	DDS
Telephone Number	:	978-443-4348

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	05/02/2017

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