Provider Demographics
NPI:1376113555
Name:BARBOUR, KIMBERLY MARION (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARION
Last Name:BARBOUR
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 1:58 CRANFORD LN
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1546
Mailing Address - Country:US
Mailing Address - Phone:313-949-6424
Mailing Address - Fax:
Practice Address - Street 1:312 CROCKER BLVD
Practice Address - Street 2:
Practice Address - City:MOUNT CLEMENS
Practice Address - State:MI
Practice Address - Zip Code:48043-2547
Practice Address - Country:US
Practice Address - Phone:586-469-6336
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-29
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901601061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist