Provider Demographics
NPI:1134651292
Name:WEBB, KIM MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:MARIE
Last Name:WEBB
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110-20 71 ROAD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-544-8787
Mailing Address - Fax:718-268-9220
Practice Address - Street 1:11020 71ST RD
Practice Address - Street 2:SUITE 120
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-4914
Practice Address - Country:US
Practice Address - Phone:718-544-8787
Practice Address - Fax:718-268-9220
Is Sole Proprietor?:No
Enumeration Date:2017-03-29
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019122124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist