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Individual

DR. KENNETH C VAN KIRK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DDS

Contact information

Practice address
1125 W KAGY BLVD, SUITE 200, BOZEMAN, MT 59715-5881
(406) 587-1688
(406) 582-5473
Mailing address
1125 W KAGY BLVD, SUITE 200, BOZEMAN, MT 59715-5881
(406) 587-1688
(406) 582-5473

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
2265
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
134932
TRI-CARE
ID
Enumeration date
08/01/2006
Last updated
03/30/2009
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