Provider Demographics
NPI:1497161038
Name:HARTE, KIMBERLY (DMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HARTE
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 1:480 ADAMS ST
Mailing Address - Street 2:#108
Mailing Address - City:MILTON
Mailing Address - State:MA
Mailing Address - Zip Code:02186-4914
Mailing Address - Country:US
Mailing Address - Phone:617-696-5257
Mailing Address - Fax:
Practice Address - Street 1:480 ADAMS ST
Practice Address - Street 2:#108
Practice Address - City:MILTON
Practice Address - State:MA
Practice Address - Zip Code:02186-4914
Practice Address - Country:US
Practice Address - Phone:617-696-5257
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18566241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice