Provider Demographics
NPI:1447257639
Name:KLUG, KIRBY LEE (DDS)
Entity type:Individual
Prefix:
First Name:KIRBY
Middle Name:LEE
Last Name:KLUG
Suffix:
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 1:8631 W 150TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-2974
Mailing Address - Country:US
Mailing Address - Phone:913-681-8668
Mailing Address - Fax:913-851-0440
Practice Address - Street 1:8631 W 150TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-2974
Practice Address - Country:US
Practice Address - Phone:913-681-8668
Practice Address - Fax:913-851-0440
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6275122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist