Provider Demographics
NPI:1467565432
Name:TAMBINI, KIMBERLY NICHELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:NICHELLE
Last Name:TAMBINI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:TAMBINI
Other - Last Name:TRUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:5319 WATERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:N CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29418-5726
Mailing Address - Country:US
Mailing Address - Phone:843-851-0104
Mailing Address - Fax:
Practice Address - Street 1:455 OLD TROLLEY RD
Practice Address - Street 2:STE E
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5669
Practice Address - Country:US
Practice Address - Phone:843-851-0104
Practice Address - Fax:843-851-0210
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC34541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3454Medicaid
SC970893OtherUNITED CONCORDIA
SCU88186Medicare UPIN