Provider Demographics
NPI:1578746970
Name:KIMBERLY, RAYMOND DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DAVID
Last Name:KIMBERLY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1852 MERRIMAN ROAD
Mailing Address - Street 2:VALLEY DENTAL GROUP INC
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44313-5295
Mailing Address - Country:US
Mailing Address - Phone:330-867-8354
Mailing Address - Fax:330-867-6960
Practice Address - Street 1:1852 MERRIMAN ROAD
Practice Address - Street 2:VALLEY DENTAL GROUP INC
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44313-5295
Practice Address - Country:US
Practice Address - Phone:330-867-8354
Practice Address - Fax:330-867-6960
Is Sole Proprietor?:No
Enumeration Date:2007-12-10
Last Update Date:2007-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30013105122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist