Provider Demographics
NPI:1538675103
Name:KIMES FAMILY DENTISTRY PLLC
Entity Type:Organization
Organization Name:KIMES FAMILY DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:KIMES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-675-2009
Mailing Address - Street 1:PO BOX 88
Mailing Address - Street 2:
Mailing Address - City:BOONEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72927-0088
Mailing Address - Country:US
Mailing Address - Phone:479-675-2009
Mailing Address - Fax:
Practice Address - Street 1:1090 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BOONEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72927
Practice Address - Country:US
Practice Address - Phone:479-675-2009
Practice Address - Fax:479-675-5446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2017-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR3882261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental