Provider Demographics
NPI:1235204041
Name:SMITH, KIMBERLY MAYS (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MAYS
Last Name:SMITH
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 1:1814 CRESHAW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061
Mailing Address - Country:US
Mailing Address - Phone:847-833-1272
Mailing Address - Fax:618-217-2367
Practice Address - Street 1:2422 MAIN ST
Practice Address - Street 2:
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60202-1548
Practice Address - Country:US
Practice Address - Phone:847-264-9330
Practice Address - Fax:618-217-2367
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0254581223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics