Provider Demographics
NPI:1326001801
Name:LOUGH, KIMBERLY T (DDS, MS)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:T
Last Name:LOUGH
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:12 KANAWHA TER
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT ALBANS
Mailing Address - State:WV
Mailing Address - Zip Code:25177-2750
Mailing Address - Country:US
Mailing Address - Phone:304-722-7221
Mailing Address - Fax:304-722-0420
Practice Address - Street 1:12 KANAWHA TER
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT ALBANS
Practice Address - State:WV
Practice Address - Zip Code:25177-2750
Practice Address - Country:US
Practice Address - Phone:304-722-7221
Practice Address - Fax:304-722-0420
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV34151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV4004039000Medicaid