Provider Demographics
NPI:1669755518
Name:KIRBY, GEORGE B (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:B
Last Name:KIRBY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 EUCLID AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44115-1623
Mailing Address - Country:US
Mailing Address - Phone:216-696-1441
Mailing Address - Fax:216-696-6667
Practice Address - Street 1:1110 EUCLID AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44115-1623
Practice Address - Country:US
Practice Address - Phone:216-696-1441
Practice Address - Fax:216-696-6667
Is Sole Proprietor?:No
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH135131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice