Provider Demographics
NPI:1821190885
Name:IRBY, MARTY RIES (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTY
Middle Name:RIES
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:PO BOX 527
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38351-0527
Mailing Address - Country:US
Mailing Address - Phone:731-968-6614
Mailing Address - Fax:731-968-6112
Practice Address - Street 1:115 S BROAD ST
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:TN
Practice Address - Zip Code:38351-2043
Practice Address - Country:US
Practice Address - Phone:731-968-6614
Practice Address - Fax:731-968-6112
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS40511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice