Provider Demographics
NPI:1033316674
Name:SMITH, KIMBERLY A (RDH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:A
Other - Last Name:MURDOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:370 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COLVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:99114-2310
Mailing Address - Country:US
Mailing Address - Phone:509-684-1440
Mailing Address - Fax:509-684-1277
Practice Address - Street 1:370 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COLVILLE
Practice Address - State:WA
Practice Address - Zip Code:99114-2310
Practice Address - Country:US
Practice Address - Phone:509-684-1440
Practice Address - Fax:509-684-1277
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00009418124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5901624Medicaid