Provider Demographics
NPI:1710015623
Name:KIRBY & VACA DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:KIRBY & VACA DENTISTRY PARTNERSHIP
Other - Org Name:VACA & KIRBY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRBY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-663-0861
Mailing Address - Street 1:3121 H G MOSELEY PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-2942
Mailing Address - Country:US
Mailing Address - Phone:903-663-0861
Mailing Address - Fax:903-663-9148
Practice Address - Street 1:3121 H G MOSELEY PKWY
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-2942
Practice Address - Country:US
Practice Address - Phone:903-663-0861
Practice Address - Fax:903-663-9148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty