Provider Demographics
NPI:1346416914
Name:KIMBERLEY A. FIREY, D.D.S., P.C.
Entity Type:Organization
Organization Name:KIMBERLEY A. FIREY, D.D.S., P.C.
Other - Org Name:BROOKTOWNE DENTISTRY
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER/BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:FIREY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:918-743-1777
Mailing Address - Street 1:1316 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-4032
Mailing Address - Country:US
Mailing Address - Phone:918-743-1777
Mailing Address - Fax:
Practice Address - Street 1:1316 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-4032
Practice Address - Country:US
Practice Address - Phone:918-743-1777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-05
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty