Provider Demographics
NPI:1073693891
Name:IRBY, PEGGY JO (RDH)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:JO
Last Name:IRBY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 COMANCHE RD
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1405
Mailing Address - Country:US
Mailing Address - Phone:719-543-8808
Mailing Address - Fax:719-543-8808
Practice Address - Street 1:2099 W. HWY. 50
Practice Address - Street 2:SUITE 180
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008
Practice Address - Country:US
Practice Address - Phone:719-543-8808
Practice Address - Fax:719-543-8808
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO903535124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist