1710015623 NPI number — KIRBY & VACA DENTISTRY PARTNERSHIP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710015623 NPI number — KIRBY & VACA DENTISTRY PARTNERSHIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIRBY & VACA DENTISTRY PARTNERSHIP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
VACA & KIRBY DENTAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710015623
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3121 H G MOSELEY PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75605-2942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-663-0861
Provider Business Mailing Address Fax Number:
903-663-9148

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3121 H G MOSELEY PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75605-2942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-663-0861
Provider Business Practice Location Address Fax Number:
903-663-9148
Provider Enumeration Date:
03/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIRBY
Authorized Official First Name:
CHRIS
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER DENTIST
Authorized Official Telephone Number:
903-663-0861

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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