Provider Demographics
NPI:1609216670
Name:BORK, KIMBERLY JEAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:JEAN
Last Name:BORK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:JEAN
Other - Last Name:YINGST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 757
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:SD
Mailing Address - Zip Code:57033-0757
Mailing Address - Country:US
Mailing Address - Phone:605-528-6750
Mailing Address - Fax:
Practice Address - Street 1:304 W. HIGHWAY 38
Practice Address - Street 2:SUITE 138
Practice Address - City:HARTFORD
Practice Address - State:SD
Practice Address - Zip Code:57033
Practice Address - Country:US
Practice Address - Phone:605-528-6750
Practice Address - Fax:605-528-6752
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD10331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice