Provider Demographics
NPI:1902299241
Name:JOSEPH L KIRBO JR
Entity Type:Organization
Organization Name:JOSEPH L KIRBO JR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRBO
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:229-247-1661
Mailing Address - Street 1:2722 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1770
Mailing Address - Country:US
Mailing Address - Phone:229-247-1661
Mailing Address - Fax:229-247-8051
Practice Address - Street 1:2722 N OAK ST
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1770
Practice Address - Country:US
Practice Address - Phone:229-247-1661
Practice Address - Fax:229-247-8051
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-11
Last Update Date:2015-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN008200261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental