Provider Demographics
NPI:1093104713
Name:THORNTON, KIMBERLY
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6169 S BALSAM WAY
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80123-3062
Mailing Address - Country:US
Mailing Address - Phone:303-933-8230
Mailing Address - Fax:303-922-1145
Practice Address - Street 1:6169 S BALSAM WAY
Practice Address - Street 2:SUITE 330
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80123-3062
Practice Address - Country:US
Practice Address - Phone:303-933-8230
Practice Address - Fax:303-922-1145
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO000002987124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO76627772OtherMEDICAID