Provider Demographics
NPI:1093287211
Name:KIMBERLY MARIE FORD, DDS, LLC
Entity Type:Organization
Organization Name:KIMBERLY MARIE FORD, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:FORD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:443-867-4928
Mailing Address - Street 1:3505 ELLICOTT MILLS DR STE B2
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4578
Mailing Address - Country:US
Mailing Address - Phone:410-461-3311
Mailing Address - Fax:410-750-7348
Practice Address - Street 1:3505 ELLICOTT MILLS DR STE B2
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4578
Practice Address - Country:US
Practice Address - Phone:410-461-3311
Practice Address - Fax:410-750-7348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1023397502OtherNPI