Active NPI
Kevin Lucas Kirk, DMD
- General Practice Dentistry
- Jacksonville, FL
National Provider Identifier
1922112143
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN14876
- Practice address
- 3965 Confederate Point Rd
Jacksonville, FL 32210-5401 - Phone
- (904) 772-0508
- NPI assigned
- Aug 17, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN14876 | FL | Primary |
Addresses
Primary practice location
3965 Confederate Point Rd
Jacksonville, FL 32210-5401
Mailing address
3742 Rustic LN
Jacksonville, FL 32217-4235
Phone (904) 739-8978
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Mar 3, 2021 through Mar 3, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN14876 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155772800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1922112143",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3742 RUSTIC LN",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322174235",
"telephone_number": "904-739-8978"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3965 CONFEDERATE POINT RD",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322105401",
"telephone_number": "904-772-0508"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRK",
"first_name": "KEVIN",
"middle_name": "LUCAS",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN14876",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.