Provider Demographics
NPI:1396860607
Name:KIMMERLING, PATRICIA WHITE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:WHITE
Last Name:KIMMERLING
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 1:2655 DALLAS HWY SW
Mailing Address - Street 2:SUITE 510
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-2597
Mailing Address - Country:US
Mailing Address - Phone:770-422-8776
Mailing Address - Fax:770-428-2207
Practice Address - Street 1:2655 DALLAS HWY SW
Practice Address - Street 2:SUITE 510
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2597
Practice Address - Country:US
Practice Address - Phone:770-422-8776
Practice Address - Fax:770-428-2207
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA9688122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist