Provider Demographics
NPI:1043428667
Name:PACKER, KIMBERLY GAIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:GAIL
Last Name:PACKER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BLENHIEM LN
Mailing Address - Street 2:SUITE D
Mailing Address - City:HAVRE DE GRACE
Mailing Address - State:MD
Mailing Address - Zip Code:21078-2040
Mailing Address - Country:US
Mailing Address - Phone:410-939-6003
Mailing Address - Fax:410-939-5003
Practice Address - Street 1:1500 BLENHIEM LN
Practice Address - Street 2:SUITE D
Practice Address - City:HAVRE DE GRACE
Practice Address - State:MD
Practice Address - Zip Code:21078-2040
Practice Address - Country:US
Practice Address - Phone:410-939-6003
Practice Address - Fax:410-939-5003
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice