Provider Demographics
NPI:1740731645
Name:WG KIRBY
Entity type:Organization
Organization Name:WG KIRBY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-627-6305
Mailing Address - Street 1:17503 LA CANTERA PARKWAY #104-606
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257
Mailing Address - Country:US
Mailing Address - Phone:210-627-6305
Mailing Address - Fax:210-681-8887
Practice Address - Street 1:8340 FM 78
Practice Address - Street 2:SUITE #2
Practice Address - City:CONVERSE
Practice Address - State:TX
Practice Address - Zip Code:78109-1080
Practice Address - Country:US
Practice Address - Phone:210-627-6305
Practice Address - Fax:210-681-8887
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX271201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty