Provider Demographics
NPI:1184630527
Name:KIM L. CAPEHART, D.D.S., P.A.
Entity Type:Organization
Organization Name:KIM L. CAPEHART, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O./PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIM
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAPEHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-963-7237
Mailing Address - Street 1:PO BOX 80035
Mailing Address - Street 2:
Mailing Address - City:SIMPSONVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29680-0001
Mailing Address - Country:US
Mailing Address - Phone:864-963-7237
Mailing Address - Fax:864-967-2375
Practice Address - Street 1:621 SE MAIN ST
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29681-3234
Practice Address - Country:US
Practice Address - Phone:864-963-7237
Practice Address - Fax:864-967-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC38421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty