Provider Demographics
NPI:1770846834
Name:KIRBY, GEORGE (MD, DDS)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:
Last Name:KIRBY
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6440 OAKRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-8999
Mailing Address - Country:US
Mailing Address - Phone:989-621-4044
Mailing Address - Fax:
Practice Address - Street 1:601 MICHIGAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423
Practice Address - Country:US
Practice Address - Phone:616-392-2329
Practice Address - Fax:616-392-9610
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010204651223S0112X
MI4301110608390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery