Individual
RUSSELL KEITH KIRK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1409 W BADDOUR PKWY, SUITE #F, LEBANON, TN 37087-2513
(615) 453-7800
(615) 453-7858
Mailing address
5594 FRANKLIN RD, LEBANON, TN 37090-8101
(615) 453-7800
(615) 453-7858
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
7103
TN
Other
Enumeration date
03/31/2006
Last updated
05/03/2011
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