Provider Demographics
NPI:1467540278
Name:WESTERMANN, KIM JEAN (DMD)
Entity Type:Individual
Prefix:MRS
First Name:KIM
Middle Name:JEAN
Last Name:WESTERMANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 WESTPORT GREEN PL
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-3136
Mailing Address - Country:US
Mailing Address - Phone:502-426-1022
Mailing Address - Fax:
Practice Address - Street 1:3200 WESTPORT GREEN PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-3136
Practice Address - Country:US
Practice Address - Phone:502-426-1022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY61201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice