| Kirby Clendenon Dds | |
|
1711 S 10th Ave Caldwell ID 83605-4839 | |
| (208) 954-9217 | |
| (208) 453-1037 |
| Full Name | Kirby Clendenon Dds |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 1711 S 10th Ave, Caldwell, Idaho |
| Authorized Official Name and Position | Kirby L Clendenon (PRESIDENT) |
| Authorized Official Contact | 2084549217 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kirby Clendenon Dds 1711 S 10th Ave Caldwell ID 83605-4839 Ph: (208) 454-9217 | Kirby Clendenon Dds 1711 S 10th Ave Caldwell ID 83605-4839 Ph: (208) 954-9217 |
| NPI Number | 1407957897 |
|---|---|
| Provider Enumeration Date | 09/26/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1407957897 | NPI | - | NPPES |
| 839559 | Other | ID | UNITED CONCORDIA |
| 69096 | Other | ID | B/C OF ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D1836 (Idaho) | Primary |
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