Provider Demographics
NPI:1558673319
Name:IRBY, MICHAEL BOWMAN (DDS)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:BOWMAN
Last Name:IRBY
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 1:4025 CHATFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-1610
Mailing Address - Country:US
Mailing Address - Phone:225-202-0770
Mailing Address - Fax:225-343-6177
Practice Address - Street 1:7604 GOODWOOD BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-7622
Practice Address - Country:US
Practice Address - Phone:225-927-7545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-09
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6089122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist