Provider Demographics
NPI:1346240561
Name:SCOTT, KIMBERLY DAWN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DAWN
Last Name:SCOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:D
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2408 WATERWHEEL DR
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-6475
Mailing Address - Country:US
Mailing Address - Phone:615-210-8430
Mailing Address - Fax:
Practice Address - Street 1:185 KIMEL PARK DR
Practice Address - Street 2:STE 202
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6973
Practice Address - Country:US
Practice Address - Phone:336-659-9500
Practice Address - Fax:615-714-1017
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7417122300000X
NC8628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist