Provider Demographics
NPI:1952459133
Name:BROWN, KIRBY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:L
Last Name:BROWN
Suffix:
Gender:M
Credentials:DMD
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 232
Mailing Address - Street 2:
Mailing Address - City:ROCKMART
Mailing Address - State:GA
Mailing Address - Zip Code:30153-0232
Mailing Address - Country:US
Mailing Address - Phone:770-684-9449
Mailing Address - Fax:770-684-3939
Practice Address - Street 1:630 GOODYEAR AVE
Practice Address - Street 2:
Practice Address - City:ROCKMART
Practice Address - State:GA
Practice Address - Zip Code:30153-2506
Practice Address - Country:US
Practice Address - Phone:770-684-9449
Practice Address - Fax:770-684-3939
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0111741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice