Individual
DR. KIRBY LYNN CLENDENON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1711 S 10TH AVE, CALDWELL, ID 83605
(208) 454-9217
(208) 453-1037
Mailing address
1711 S 10TH AVE, CALDWELL, ID 83605
(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
BC OF ID
—
01
—
839559
UNITED CONCORDIA
—
Enumeration date
08/31/2006
Last updated
07/08/2007
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