Provider Demographics
NPI:1346256880
Name:KIMBROUGH, ANITA MAHALIA (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANITA
Middle Name:MAHALIA
Last Name:KIMBROUGH
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 1:7171 REMAGEN ST
Mailing Address - Street 2:
Mailing Address - City:FORT HOOD
Mailing Address - State:TX
Mailing Address - Zip Code:76544-1785
Mailing Address - Country:US
Mailing Address - Phone:214-923-2985
Mailing Address - Fax:
Practice Address - Street 1:36000 DARNALL LOOP STE 1051
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5095
Practice Address - Country:US
Practice Address - Phone:254-287-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice