Jeff Van Kirk, Dmd, PC
Dentist, General Practice in Stayton, OR. Organization (NPI-2).
NPI number1124440417
StatusActive
Last updated in NPPESJan 6, 2014
Details
- NPI
- 1124440417
- Entity type
- Organization (NPI-2)
- Legal business name
- Jeff Van Kirk, Dmd, PC
- Organization subpart
- No
- Enumeration date
- Jan 6, 2014
- Last updated
- Jan 6, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | D9848 | OR | Yes |
Practice location
450 E Washington StStayton, OR 97383-1837
Phone 503-769-6351 · Fax 503-759-7029
Mailing address
1390 Alpine Lakes St SeSalem, OR 97317-6976
Phone 216-394-3140
Authorized official
Jeff Scott Van Kirk
President, General Dentist
2163943140
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