Provider Demographics
NPI:1457646580
Name:ST. AMANT, KIM MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:MARIE
Last Name:ST. AMANT
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 1:1300 SPRING ST STE 134
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3653
Mailing Address - Country:US
Mailing Address - Phone:301-587-4771
Mailing Address - Fax:301-587-6323
Practice Address - Street 1:1300 SPRING ST STE 134
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3653
Practice Address - Country:US
Practice Address - Phone:301-587-4771
Practice Address - Fax:301-587-6323
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD8027122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist