Active NPI
Phillip D. Kirby, D.D.S.
- General Practice Dentistry
- Kingsport, TN
National Provider Identifier
1477623197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DS2736
- Practice address
- 1420 E Stone Dr
Suite G
Kingsport, TN 37660-4165 - Phone
- (423) 247-6961
- Fax
- (423) 247-5552
- NPI assigned
- Nov 9, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DS2736 | TN | Primary |
Addresses
Primary practice location
1420 E Stone Dr
Suite G
Kingsport, TN 37660-4165
Mailing address
1420 E Stone Dr
Suite G
Kingsport, TN 37660-4165
Phone (423) 247-6961
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0087211 | Other | TN | BCBS TN |
| 241197 | Other | VA | TRIGON |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DS2736 | TN | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163030400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1477623197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1420 E STONE DR",
"address_2": "SUITE G",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376604165",
"telephone_number": "423-247-6961",
"fax_number": "423-247-5552"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1420 E STONE DR",
"address_2": "SUITE G",
"city": "KINGSPORT",
"state": "TN",
"postal_code": "376604165",
"telephone_number": "423-247-6961",
"fax_number": "423-247-5552"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIRBY",
"first_name": "PHILLIP",
"middle_name": "D.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TN",
"license": "DS2736",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS TN",
"identifier": "0087211",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRIGON",
"identifier": "241197",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kingsport, TN
- Kingsport Psychiatry & Counseling Services, PLLC
- Kingsport Senior House, LLC (The Village at Allandale)
- Kingsport TN Ophthalmology ASC LLC (Regional Eye Surgery Center)
- Kingsport TN Ophthalmology ASC LLC (The Regional Eye Surgery Center)
- Kingsport Urology Group
- Kevin P Kirk, MD
- Richard B Kirk, MSW LCSW
- Heather L Kistner, M.S., CCC-A
- Peter John Kitching, OT
- Amy F Kite, PA, ASCP (CM)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.