NPIMap

Organization Active NPI

Kirby Clendenon DDS

  • General Practice Dentistry
  • Caldwell, ID
National Provider Identifier
1407957897
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D1836 Issued in ID
Legal business name
KIRBY CLENDENON DDS
Practice address
1711 S 10TH Ave
Caldwell, ID 83605-4839
Phone
(208) 954-9217
Fax
(208) 453-1037
NPI assigned
Sep 26, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kirby L Clendenon, DDSNPI 1942311196
Title
President
Phone
(208) 454-9217

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X D1836 ID Primary

Addresses

Primary practice location

1711 S 10TH Ave
Caldwell, ID 83605-4839

Mailing address

1711 S 10TH Ave
Caldwell, ID 83605-4839
Phone (208) 454-9217

Other identifiers 2

IdentifierTypeStateIssuer
839559OtherIDUNITED CONCORDIA
69096OtherIDB/C OF ID

National Provider Directory

National Provider Directory

Locations

1711 S 10th Ave
Caldwell, ID 83605
Phone (208) 454-9217

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1407957897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1711 S 10TH AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054839",
            "telephone_number": "208-454-9217",
            "fax_number": "208-453-1037"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1711 S 10TH AVE",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054839",
            "telephone_number": "208-954-9217",
            "fax_number": "208-453-1037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIRBY CLENDENON DDS",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "CLENDENON",
        "authorized_official_first_name": "KIRBY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-454-9217",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "839559",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "B/C OF ID",
            "identifier": "69096",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.