Provider Demographics
NPI:1063839769
Name:CHRISTIE, KIMBERLY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:HAYWARD
Other - Middle Name:BENTON
Other - Last Name:DRANE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:1 CHESLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063
Mailing Address - Country:US
Mailing Address - Phone:610-566-6649
Mailing Address - Fax:610-566-6740
Practice Address - Street 1:1 CHESLEY DRIVE
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063
Practice Address - Country:US
Practice Address - Phone:610-566-6649
Practice Address - Fax:610-566-6740
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368521223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics