Provider Demographics
NPI:1295464154
Name:ZEEB, KIMBERLY SOPHIA (RDH BS EPDH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SOPHIA
Last Name:ZEEB
Suffix:
Gender:F
Credentials:RDH BS EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17240 BECK RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:OR
Mailing Address - Zip Code:97338-9317
Mailing Address - Country:US
Mailing Address - Phone:503-931-5236
Mailing Address - Fax:
Practice Address - Street 1:244 E ELLENDALE AVE STE 4
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:OR
Practice Address - Zip Code:97338-1523
Practice Address - Country:US
Practice Address - Phone:971-239-1624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-07
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4377124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty