Provider Demographics
NPI:1750391074
Name:KIRBY, DOUGLAS F
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:F
Last Name:KIRBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 BARLOW ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-4313
Mailing Address - Country:US
Mailing Address - Phone:231-947-2390
Mailing Address - Fax:231-947-0373
Practice Address - Street 1:1429 BARLOW ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4313
Practice Address - Country:US
Practice Address - Phone:231-947-2390
Practice Address - Fax:231-947-0373
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010090651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice