Provider Demographics
NPI:1144354648
Name:DEHLER, KIMBERLY (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:DEHLER
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 1:280 CONCORD PKWY S
Mailing Address - Street 2:SUITE 110 A
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-6730
Mailing Address - Country:US
Mailing Address - Phone:704-920-1070
Mailing Address - Fax:
Practice Address - Street 1:280 CONCORD PKWY S
Practice Address - Street 2:SUTE 110 A
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-6730
Practice Address - Country:US
Practice Address - Phone:704-920-1070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC78291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC79902V3Medicaid
NC902V3OtherBCBC