Provider Demographics
NPI:1285077495
Name:KIRBY, JOE KENT JR (DDS)
Entity type:Individual
Prefix:
First Name:JOE
Middle Name:KENT
Last Name:KIRBY
Suffix:JR
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 1:1187 COAST VILLAGE RD # 1103
Mailing Address - Street 2:
Mailing Address - City:MONTECITO
Mailing Address - State:CA
Mailing Address - Zip Code:93108-2737
Mailing Address - Country:US
Mailing Address - Phone:805-928-6776
Mailing Address - Fax:805-928-6788
Practice Address - Street 1:550 CANAL ST STE A
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3455
Practice Address - Country:US
Practice Address - Phone:805-928-6776
Practice Address - Fax:805-928-6788
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35131122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist