Provider Demographics
NPI:1609971811
Name:CENTENO, KIMBERLY N/A (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:N/A
Last Name:CENTENO
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 1:4307 STAGECOACH RD
Mailing Address - Street 2:
Mailing Address - City:DUNSMUIR
Mailing Address - State:CA
Mailing Address - Zip Code:96025-1812
Mailing Address - Country:US
Mailing Address - Phone:530-235-2531
Mailing Address - Fax:530-235-0821
Practice Address - Street 1:4307 STAGECOACH RD
Practice Address - Street 2:
Practice Address - City:DUNSMUIR
Practice Address - State:CA
Practice Address - Zip Code:96025-1812
Practice Address - Country:US
Practice Address - Phone:530-235-2531
Practice Address - Fax:530-235-0821
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52457122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist