Provider Demographics
NPI:1609929777
Name:KIRBY, KAREN C (DDS)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:C
Last Name:KIRBY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 MILES AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44105-5521
Mailing Address - Country:US
Mailing Address - Phone:216-751-3100
Mailing Address - Fax:216-231-2480
Practice Address - Street 1:1800 LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44052-3781
Practice Address - Country:US
Practice Address - Phone:440-233-0100
Practice Address - Fax:440-233-2400
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2011-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020443122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2481158Medicaid
T45861Medicare UPIN
OH2481158Medicaid