Provider Demographics
NPI:1164655890
Name:DONDICI-CHERMOL, KIMBERLY A (DMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:DONDICI-CHERMOL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 W. LANCASTER AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003
Mailing Address - Country:US
Mailing Address - Phone:610-642-3417
Mailing Address - Fax:610-642-2447
Practice Address - Street 1:42 W. LANCASTER AVENUE
Practice Address - Street 2:SUITE 100
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003
Practice Address - Country:US
Practice Address - Phone:610-642-3417
Practice Address - Fax:610-642-2447
Is Sole Proprietor?:No
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAD5027639L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry