Provider Demographics
NPI:1215060801
Name:NORBO, KIRK MYRON (DMD)
Entity type:Individual
Prefix:
First Name:KIRK
Middle Name:MYRON
Last Name:NORBO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 300
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20134-0300
Mailing Address - Country:US
Mailing Address - Phone:540-338-7328
Mailing Address - Fax:540-338-9117
Practice Address - Street 1:441 E MAIN ST
Practice Address - Street 2:
Practice Address - City:PURCELLVEILL
Practice Address - State:VA
Practice Address - Zip Code:20132
Practice Address - Country:US
Practice Address - Phone:540-338-7325
Practice Address - Fax:540-338-9117
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010062261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice