# KIRBY CLENDENON DDS

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1407957897
- **Authorized official:** KIRBY L CLENDENON DDS (PRESIDENT)
- **Authorized official phone:** (208) 454-9217

## Contact information

- **Practice address:** 1711 S 10TH AVE, CALDWELL, ID 83605-4839
- **Practice address phone:** (208) 954-9217
- **Practice address fax:** (208) 453-1037
- **Mailing address:** 1711 S 10TH AVE, CALDWELL, ID 83605-4839
- **Mailing address phone:** (208) 454-9217
- **Mailing address fax:** (208) 453-1037

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | D1836 | ID | Yes |

## Other

- **Enumeration date:** 09/26/2006
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 69096 | B/C OF ID | ID |
| 01 | — | 839559 | UNITED CONCORDIA | ID |