Provider Demographics
NPI:1972940914
Name:KIRBY, KIALA JEAN (RDH)
Entity type:Individual
Prefix:MRS
First Name:KIALA
Middle Name:JEAN
Last Name:KIRBY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 BROWNS LN
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-7226
Mailing Address - Country:US
Mailing Address - Phone:870-972-8294
Mailing Address - Fax:870-972-0460
Practice Address - Street 1:2606 BROWNS LN
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-7226
Practice Address - Country:US
Practice Address - Phone:870-972-8294
Practice Address - Fax:870-972-0460
Is Sole Proprietor?:No
Enumeration Date:2013-05-31
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2372124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist