Provider Demographics
NPI:1912077462
Name:CLEMENTS, KIRBY SR (DDS MSCD)
Entity type:Individual
Prefix:DR
First Name:KIRBY
Middle Name:
Last Name:CLEMENTS
Suffix:SR
Gender:M
Credentials:DDS MSCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4555 FLAT SHOALS PKWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DECATUR
Mailing Address - State:CA
Mailing Address - Zip Code:30034
Mailing Address - Country:US
Mailing Address - Phone:404-241-7710
Mailing Address - Fax:404-241-8497
Practice Address - Street 1:4555 FLAT SHOALS PKWY
Practice Address - Street 2:SUITE 102
Practice Address - City:DECATUR
Practice Address - State:CA
Practice Address - Zip Code:30034
Practice Address - Country:US
Practice Address - Phone:404-241-7710
Practice Address - Fax:404-241-8497
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA86491223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics