Provider Demographics
NPI:1477767440
Name:CONANT, KIMBERLY BAUCHE (DDS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:BAUCHE
Last Name:CONANT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:ANN
Other - Last Name:BAUCHE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:5135 N CAMINO ESPLENDORA
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-6226
Mailing Address - Country:US
Mailing Address - Phone:520-722-1699
Mailing Address - Fax:
Practice Address - Street 1:2141 N BEVERLY AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2155
Practice Address - Country:US
Practice Address - Phone:520-795-0982
Practice Address - Fax:520-795-1434
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6809122300000X
CA45354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist