Provider Demographics
NPI:1609995695
Name:FIREY, KIMBERLEY ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:ANN
Last Name:FIREY
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 1:1316 E 41ST ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-4032
Mailing Address - Country:US
Mailing Address - Phone:918-743-1777
Mailing Address - Fax:918-743-1780
Practice Address - Street 1:1316 E 41ST ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-4032
Practice Address - Country:US
Practice Address - Phone:918-743-1777
Practice Address - Fax:918-743-1780
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKOK52761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice