Provider Demographics
NPI:1619051828
Name:WEYNETH, KIMBERLY (DDS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:WEYNETH
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 1:11115 GLENBROOK LN
Mailing Address - Street 2:
Mailing Address - City:INDIANHEAD PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60525-6984
Mailing Address - Country:US
Mailing Address - Phone:708-246-2889
Mailing Address - Fax:
Practice Address - Street 1:152 N ADDISON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2810
Practice Address - Country:US
Practice Address - Phone:630-530-8852
Practice Address - Fax:630-530-8861
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice