Active NPI
Walter Charles Kirk Jr, DMD
- Periodontics
- Fuquay Varina, NC
National Provider Identifier
1457403156
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Periodontics
- License
- 6745
- Practice address
- 1213 N Main St
Fuquay Varina, NC 27526-2616 - Phone
- (919) 552-9711
- NPI assigned
- Jan 16, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Periodontics | 1223P0300X | 6745 | NC | Primary |
Addresses
Primary practice location
1213 N Main St
Fuquay Varina, NC 27526-2616
Mailing address
105 Breezewood Dr
Goldsboro, NC 27534-8901
Phone (919) 778-8469
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 8990142 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6745 | NC | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lane and Associates I DDS PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- General Practice Dentistry
- Fuquay Varina, NC
- NPI 1154336642
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168905600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1457403156",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "105 BREEZEWOOD DR",
"city": "GOLDSBORO",
"state": "NC",
"postal_code": "275348901",
"telephone_number": "919-778-8469"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1213 N MAIN ST",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275262616",
"telephone_number": "919-552-9711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRK JR",
"first_name": "WALTER",
"middle_name": "CHARLES",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-16",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223P0300X",
"taxonomy_group": "",
"desc": "Dentist, Periodontics",
"state": "NC",
"license": "6745",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8990142",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fuquay Varina, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.