Provider Demographics
NPI:1598884793
Name:HARRADINE, KIMBERLY REED (DMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:REED
Last Name:HARRADINE
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 1:2121 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-3901
Mailing Address - Country:US
Mailing Address - Phone:205-933-1291
Mailing Address - Fax:205-930-9029
Practice Address - Street 1:2121 14TH AVE S
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35205-3901
Practice Address - Country:US
Practice Address - Phone:205-933-1291
Practice Address - Fax:205-930-9029
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL50481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALBH6893920OtherDEA NUMBER