Provider Demographics
NPI:1871697490
Name:SHILLINGER, KIRK M (DDS)
Entity type:Individual
Prefix:MR
First Name:KIRK
Middle Name:M
Last Name:SHILLINGER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7012 NE 40TH ST
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-3052
Mailing Address - Country:US
Mailing Address - Phone:360-254-5254
Mailing Address - Fax:360-944-3835
Practice Address - Street 1:19111 SE 34TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98683-1449
Practice Address - Country:US
Practice Address - Phone:360-823-0427
Practice Address - Fax:360-823-0428
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000087301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0158868OtherLABOR & INDUSTRIES
WA8932839OtherWA ST CRIME VICTIMS
WA5034970Medicaid