Provider Demographics
NPI:1053404178
Name:KIRKPATRICK, ALLEN RICHARD (DDS)
Entity type:Individual
Prefix:
First Name:ALLEN
Middle Name:RICHARD
Last Name:KIRKPATRICK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N 116 MAIN
Mailing Address - Street 2:
Mailing Address - City:COLFAX
Mailing Address - State:WA
Mailing Address - Zip Code:99111-1801
Mailing Address - Country:US
Mailing Address - Phone:509-397-4077
Mailing Address - Fax:509-397-6766
Practice Address - Street 1:N 116 MAIN
Practice Address - Street 2:
Practice Address - City:COLFAX
Practice Address - State:WA
Practice Address - Zip Code:99111-1801
Practice Address - Country:US
Practice Address - Phone:509-397-4077
Practice Address - Fax:509-397-6766
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000052761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA05513OtherWDS
WA5551304Medicaid