Provider Demographics
NPI:1497963342
Name:WIMBLEY, MINDY LYNNE (CDA,RDA)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:LYNNE
Last Name:WIMBLEY
Suffix:
Gender:F
Credentials:CDA,RDA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:819 BELFAST ST
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37801-4503
Mailing Address - Country:US
Mailing Address - Phone:865-257-0454
Mailing Address - Fax:865-691-4291
Practice Address - Street 1:323 FOX RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3383
Practice Address - Country:US
Practice Address - Phone:865-690-5231
Practice Address - Fax:865-691-4291
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN10631126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant