Provider Demographics
NPI:1679758734
Name:KIRBY J. RANSOM DMD PA II
Entity Type:Organization
Organization Name:KIRBY J. RANSOM DMD PA II
Other - Org Name:GIBSONVILLE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:J
Authorized Official - Last Name:RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-449-6423
Mailing Address - Street 1:P O BOX 198
Mailing Address - Street 2:408 BURLINGTON AVE
Mailing Address - City:GIBSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27249-0198
Mailing Address - Country:US
Mailing Address - Phone:336-449-6423
Mailing Address - Fax:336-449-9200
Practice Address - Street 1:408 BURLINGTON AVE
Practice Address - Street 2:
Practice Address - City:GIBSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:27249-0198
Practice Address - Country:US
Practice Address - Phone:336-449-6423
Practice Address - Fax:336-449-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2008-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty