Kirby Lynn Clendenon, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D1836 Issued in ID

Practice address

1711 S 10TH Ave
Caldwell, ID 83605

Phone

(208) 454-9217

Fax

(208) 453-1037

NPI assigned

Aug 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kirby Clendenon DDS

  • General Practice Dentistry
  • Caldwell, ID
  • NPI 1407957897
  NPD (past) Authorized official

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1942311196",
    "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": "83605",
            "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": "83605",
            "telephone_number": "208-454-9217",
            "fax_number": "208-453-1037"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLENDENON",
        "first_name": "KIRBY",
        "middle_name": "LYNN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D1836",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF ID",
            "identifier": "69096",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORDIA",
            "identifier": "839559",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chiropractic & Rehabilitation PC
• Christensen Dental PLLC
• Robert Christensen
• Deann R Christian, LPC, NCC
• Clearview Ultrasound Inc.
• Hannah Cliff, PA-C
• Clock Tower Dental PA
• Clock Tower Orthodontics, PC
• Club 32 Dental Caldwell PLLC
• Rachelle Melisa Coca, DDS

• General Practice Dentistry in Caldwell, ID
• Providers in Caldwell, ID by specialty
• General Practice Dentistry in Idaho

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.