Provider Demographics
NPI:1144322231
Name:KEARBEY DENTAL GROUP
Entity type:Organization
Organization Name:KEARBEY DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KEARBEY, DDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:530-533-0200
Mailing Address - Street 1:2690 OLIVE HWY
Mailing Address - Street 2:
Mailing Address - City:OROVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95966-6107
Mailing Address - Country:US
Mailing Address - Phone:530-533-0200
Mailing Address - Fax:
Practice Address - Street 1:2690 OLIVE HWY
Practice Address - Street 2:
Practice Address - City:OROVILLE
Practice Address - State:CA
Practice Address - Zip Code:95966-6107
Practice Address - Country:US
Practice Address - Phone:530-533-0200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty