Provider Demographics
NPI:1811730922
Name:KIRK, SANDY MICHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:SANDY
Middle Name:MICHELLE
Last Name:KIRK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SANDY
Other - Middle Name:MICHELLE
Other - Last Name:GOMEZ-HENRIQUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4036 QUARLES CT
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:VA
Mailing Address - Zip Code:22801-8716
Mailing Address - Country:US
Mailing Address - Phone:540-433-2800
Mailing Address - Fax:
Practice Address - Street 1:4036 QUARLES CT
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:VA
Practice Address - Zip Code:22801-8716
Practice Address - Country:US
Practice Address - Phone:540-433-2800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014197151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice