Provider Demographics
NPI:1477853257
Name:NICOL, KIMBERLY STEVENS (DMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:STEVENS
Last Name:NICOL
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 1:1821 DELONG RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40515-9505
Mailing Address - Country:US
Mailing Address - Phone:859-539-1529
Mailing Address - Fax:
Practice Address - Street 1:1821 DELONG RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40515-9505
Practice Address - Country:US
Practice Address - Phone:859-539-1529
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014114781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice