Provider Demographics
NPI:1548273436
Name:KIRKPATRICK, DENAE MICAE (DDS)
Entity type:Individual
Prefix:DR
First Name:DENAE
Middle Name:MICAE
Last Name:KIRKPATRICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4320 COVINGTON CT
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2316
Mailing Address - Country:US
Mailing Address - Phone:405-271-4750
Mailing Address - Fax:405-271-4055
Practice Address - Street 1:1200 N. PHILLIPS AVE.
Practice Address - Street 2:SUITE 8900
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104
Practice Address - Country:US
Practice Address - Phone:405-271-4750
Practice Address - Fax:405-271-4055
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100120360AMedicaid