Provider Demographics
NPI:1568478907
Name:CAPEHART, KIM LEE (DDS, PHD, MBA)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:LEE
Last Name:CAPEHART
Suffix:
Gender:M
Credentials:DDS, PHD, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 JOHN WESLEY GILBERT DRIVE
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30912-0001
Mailing Address - Country:US
Mailing Address - Phone:706-721-2371
Mailing Address - Fax:
Practice Address - Street 1:1430 JOHN WESLEY GILBERT DR
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-3234
Practice Address - Country:US
Practice Address - Phone:706-721-4276
Practice Address - Fax:706-721-6778
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0156101223G0001X, 1223G0001X
SC38421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZX3842Medicaid
GA003236054AMedicaid