Provider Demographics
NPI:1508161027
Name:KIRBY, MARK ALAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALAN
Last Name:KIRBY
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 1:470 W 24TH ST
Mailing Address - Street 2:9B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-1205
Mailing Address - Country:US
Mailing Address - Phone:917-478-1447
Mailing Address - Fax:
Practice Address - Street 1:470 W 24TH ST
Practice Address - Street 2:9B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-1205
Practice Address - Country:US
Practice Address - Phone:917-478-1447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2015-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY035065122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist