Provider Demographics
NPI:1487746822
Name:WILLIAM IRBY JR DDS PC
Entity type:Organization
Organization Name:WILLIAM IRBY JR DDS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:IRBY
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-676-8001
Mailing Address - Street 1:PO BOX 397
Mailing Address - Street 2:
Mailing Address - City:KENBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:23944-0397
Mailing Address - Country:US
Mailing Address - Phone:434-676-8001
Mailing Address - Fax:434-676-8002
Practice Address - Street 1:107 S. BROAD ST.
Practice Address - Street 2:
Practice Address - City:KENBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:23944
Practice Address - Country:US
Practice Address - Phone:434-676-8001
Practice Address - Fax:434-676-8002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2018-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010058371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty