Individual
WALTER CHARLES KIRK JR
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
1213 N MAIN ST, FUQUAY VARINA, NC 27526-2616
(919) 552-9711
Mailing address
105 BREEZEWOOD DR, GOLDSBORO, NC 27534-8901
(919) 778-8469
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
6745
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8990142
—
NC
Enumeration date
01/16/2007
Last updated
07/08/2007
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