Organization
KIRBY CLENDENON DDS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIRBY L CLENDENON DDS (PRESIDENT)
(208) 454-9217
Entity
Organization
Contact information
Practice address
1711 S 10TH AVE, CALDWELL, ID 83605-4839
(208) 954-9217
(208) 453-1037
Mailing address
1711 S 10TH AVE, CALDWELL, ID 83605-4839
(208) 454-9217
(208) 453-1037
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D1836
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
69096
B/C OF ID
ID
01
—
839559
UNITED CONCORDIA
ID
Enumeration date
09/26/2006
Last updated
08/22/2020
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