Provider Demographics
NPI:1588004873
Name:BARCLAY, KIMBERLEY ALEXANDRA (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:ALEXANDRA
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 WALTER SEAHOLM DR # LR160
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-0019
Mailing Address - Country:US
Mailing Address - Phone:512-949-8202
Mailing Address - Fax:
Practice Address - Street 1:211 WALTER SEAHOLM DR # LR160
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-0019
Practice Address - Country:US
Practice Address - Phone:512-949-8202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29096122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist