Provider Demographics
NPI:1134247265
Name:KIRBY J. RANSOM DMD PA
Entity type:Organization
Organization Name:KIRBY J. RANSOM DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRBY
Authorized Official - Middle Name:JEREL
Authorized Official - Last Name:RANSOM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:252-492-7563
Mailing Address - Street 1:215 CHARLES D ROLLINS RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-2883
Mailing Address - Country:US
Mailing Address - Phone:252-492-7563
Mailing Address - Fax:
Practice Address - Street 1:215 CHARLES D ROLLINS RD
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-2883
Practice Address - Country:US
Practice Address - Phone:252-492-7563
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty