Provider Demographics
NPI:1497194369
Name:CRABTREE, KIMBERLY SUE (RDH, RDA)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:SUE
Last Name:CRABTREE
Suffix:
Gender:F
Credentials:RDH, RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7040 MCKAY RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-9261
Mailing Address - Country:US
Mailing Address - Phone:517-740-2596
Mailing Address - Fax:517-536-0957
Practice Address - Street 1:7040 MCKAY RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-9261
Practice Address - Country:US
Practice Address - Phone:517-740-2596
Practice Address - Fax:517-536-0957
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2903001264124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist