Provider Demographics
NPI:1609910983
Name:KIMBLE, FELISHA D (DDS)
Entity Type:Individual
Prefix:DR
First Name:FELISHA
Middle Name:D
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MORNING GLORY CT
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22554-2639
Mailing Address - Country:US
Mailing Address - Phone:540-426-8357
Mailing Address - Fax:
Practice Address - Street 1:120 MORNING GLORY CT
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:VA
Practice Address - Zip Code:22554-2639
Practice Address - Country:US
Practice Address - Phone:540-426-8357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014108441223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist