Tracy Marie Kirk, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

29655 Issued in TX

Practice address

6300 N Beach St
Haltom City, TX 76137-2622

Phone

(817) 281-3100

Fax

(817) 788-5984

NPI assigned

Jun 22, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fossil Creek Family Dental Care, PA

  • General Practice Dentistry
  • Fort Worth, TX
  • NPI 1861509796
  NPD (past)
• Tracy Kirk DDS, PLLC

  • General Practice Dentistry
  • Ft Worth, TX
  • NPI 1992249239
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1340323200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1522281600000",
    "number": "1124381298",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6300 N BEACH ST",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "761372622",
            "telephone_number": "817-281-3100",
            "fax_number": "817-788-5984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6300 N BEACH ST",
            "city": "HALTOM CITY",
            "state": "TX",
            "postal_code": "761372622",
            "telephone_number": "817-281-3100",
            "fax_number": "817-788-5984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRK",
        "first_name": "TRACY",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-06-22",
        "last_updated": "2018-03-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "TX",
            "license": "29655",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901020720",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• JLM Delesandri LLC
• Yo Han Kim, DDS
• Carie C King, D.D.S
• James Richard King Jr., D.D.S.
• Rebecca Kinzie, PTA
• Weldon Koech
• Shiv K Kohli, DDS
• Lafleur Dental Inc., P.C.
• Lavang Healthcare Corporation
• Cheryl Lescovensky

• Dentist in Haltom City, TX
• Providers in Haltom City, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.