Provider Demographics
NPI:1346643970
Name:ARTIS, KIMBERLY MONTGOMERY (RDH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MONTGOMERY
Last Name:ARTIS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:CROWNPOINT
Mailing Address - State:NM
Mailing Address - Zip Code:87313-0358
Mailing Address - Country:US
Mailing Address - Phone:505-786-6283
Mailing Address - Fax:505-786-6394
Practice Address - Street 1:HWY JUNCTION 371 AND ROUTE 9
Practice Address - Street 2:CROWNPOINT HEALTHCARE FACILITY
Practice Address - City:CROWNPOINT
Practice Address - State:NM
Practice Address - Zip Code:87313-0358
Practice Address - Country:US
Practice Address - Phone:505-786-6283
Practice Address - Fax:505-786-6394
Is Sole Proprietor?:No
Enumeration Date:2014-09-26
Last Update Date:2014-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL020013169124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist