Provider Demographics
NPI:1649683541
Name:KILBY, DUSTIN ROSS (DMD)
Entity type:Individual
Prefix:DR
First Name:DUSTIN
Middle Name:ROSS
Last Name:KILBY
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2704 N OAK ST
Mailing Address - Street 2:BLDG C1
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-1796
Mailing Address - Country:US
Mailing Address - Phone:229-247-0200
Mailing Address - Fax:229-241-7474
Practice Address - Street 1:2704 N OAK ST BLDG C1
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31602-1796
Practice Address - Country:US
Practice Address - Phone:229-247-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-09
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014756122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist