Provider Demographics
NPI:1588798342
Name:MARY L. KALIMNIOS, D.M.D.
Entity Type:Organization
Organization Name:MARY L. KALIMNIOS, D.M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:KALIMNIOS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-259-2161
Mailing Address - Street 1:402 N BABCOCK ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6787
Mailing Address - Country:US
Mailing Address - Phone:321-259-2161
Mailing Address - Fax:321-259-2728
Practice Address - Street 1:402 N BABCOCK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6787
Practice Address - Country:US
Practice Address - Phone:321-259-2161
Practice Address - Fax:321-259-2728
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL151871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty