Provider Demographics
NPI:1518086461
Name:THOMAS, KIMBERLY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 HIDDEN TIMBER DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1598
Mailing Address - Country:US
Mailing Address - Phone:248-391-3494
Mailing Address - Fax:
Practice Address - Street 1:3226 HIDDEN TIMBER DR
Practice Address - Street 2:SUITE D
Practice Address - City:ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1598
Practice Address - Country:US
Practice Address - Phone:248-391-3494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010159141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice