Healthcare Provider Details

I. General information

NPI: 1508245663
Provider Name (Legal Business Name): KIRBY J. ROBINSON, DDS OF MISSOURI, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2609 N KANSAS EXPY
SPRINGFIELD MO
65803-1114
US

IV. Provider business mailing address

2609 N KANSAS EXPY
SPRINGFIELD MO
65803-1114
US

V. Phone/Fax

Practice location:
  • Phone: 417-501-8922
  • Fax:
Mailing address:
  • Phone: 417-501-8922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number11904
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: HALEY WOOSTER
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 984-251-8846