Provider Demographics
NPI:1033207154
Name:HART, KIRBY LAMAR III (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:LAMAR
Last Name:HART
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 S 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36344-1616
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:AL
Practice Address - Zip Code:36344-1616
Practice Address - Country:US
Practice Address - Phone:334-588-6684
Practice Address - Fax:334-588-2903
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009972630Medicaid
AL009972630Medicaid