Provider Demographics
NPI:1841390259
Name:KIRBY, CLARENCE WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLARENCE
Middle Name:WILLIAM
Last Name:KIRBY
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 1:221 FORESTROAD DRIVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24540-6103
Mailing Address - Country:US
Mailing Address - Phone:434-836-2971
Mailing Address - Fax:
Practice Address - Street 1:200 H.G. MCGHEE DRIVE
Practice Address - Street 2:
Practice Address - City:CHATHAM
Practice Address - State:VA
Practice Address - Zip Code:24531-0000
Practice Address - Country:US
Practice Address - Phone:434-432-7232
Practice Address - Fax:434-432-7235
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010068271223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA81046Medicare UPIN