# RUSSELL K KIRK, DDS, PC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Tennessee Implant & Oral Surgery
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831361013
- **Authorized official:** DR. RUSSELL KEITH KIRK DDS (PRESIDENT)
- **Authorized official phone:** (615) 453-7800

## Contact information

- **Practice address:** 1409 WEST BADDOUR PARKWAY, SUITE F, LEBANON, TN 37087
- **Practice address phone:** (615) 453-7800
- **Practice address fax:** (615) 453-7858
- **Mailing address:** 1409 WEST BADDOUR PARKWAY, SUITE F, LEBANON, TN 37087
- **Mailing address phone:** (615) 453-7800
- **Mailing address fax:** (615) 453-7858

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 7103 | TN | Yes |

## Other

- **Enumeration date:** 03/28/2008
- **Last updated:** 05/03/2011