Provider Demographics
NPI:1346017902
Name:DALLSTREAM, KYMBERLEY BETH (RDH, BSDH)
Entity Type:Individual
Prefix:
First Name:KYMBERLEY
Middle Name:BETH
Last Name:DALLSTREAM
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4933 DARLENE DR
Mailing Address - Street 2:
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-1823
Mailing Address - Country:US
Mailing Address - Phone:847-204-5670
Mailing Address - Fax:
Practice Address - Street 1:270 CENTER DR
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-1564
Practice Address - Country:US
Practice Address - Phone:847-996-0575
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-05
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020010027124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist