Provider Demographics
NPI:1073615423
Name:GARRETT, KIRBY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:L
Last Name:GARRETT
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 1:1602 SALEM RD
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1916
Mailing Address - Country:US
Mailing Address - Phone:361-575-9577
Mailing Address - Fax:361-575-4990
Practice Address - Street 1:1602 SALEM RD
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1916
Practice Address - Country:US
Practice Address - Phone:361-575-9577
Practice Address - Fax:361-575-4990
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX170791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice