Provider Demographics
NPI:1578602645
Name:KIMBERLY J. FABRE, DDS, PA
Entity Type:Organization
Organization Name:KIMBERLY J. FABRE, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:JAYE
Authorized Official - Last Name:FABRE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:941-792-0944
Mailing Address - Street 1:501 VILLAGE GREEN PKWY STE 8
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34209-3401
Mailing Address - Country:US
Mailing Address - Phone:941-792-0944
Mailing Address - Fax:
Practice Address - Street 1:501 VILLAGE GREEN PKWY STE 8
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-3401
Practice Address - Country:US
Practice Address - Phone:941-792-0944
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN141791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty