Provider Demographics
NPI:1598767030
Name:HOETKER, KIRBY CHAMBERS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:CHAMBERS
Last Name:HOETKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 STONECREST RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-8164
Mailing Address - Country:US
Mailing Address - Phone:502-633-4441
Mailing Address - Fax:502-633-4470
Practice Address - Street 1:141 STONECREST RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-8164
Practice Address - Country:US
Practice Address - Phone:502-633-4441
Practice Address - Fax:502-633-4470
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY76011223P0221X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7601OtherDENTAL LICENSE #
KY421536088OtherTAX ID
KY60001377Medicaid