Provider Demographics
NPI:1164484390
Name:ATHERTON, KIMBERLYN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLYN
Middle Name:R
Last Name:ATHERTON
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 1:245 BOULDER DR
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30075-4158
Mailing Address - Country:US
Mailing Address - Phone:540-230-7835
Mailing Address - Fax:540-951-2268
Practice Address - Street 1:245 BOULDER DR
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30075-4158
Practice Address - Country:US
Practice Address - Phone:540-230-7835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410261122300000X
GADN0159251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist