Provider Demographics
NPI:1619071222
Name:BACHMANN, KIMBERLY J (DDS)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:J
Last Name:BACHMANN
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 1:869 N CENTRE PKWY
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47872-8035
Mailing Address - Country:US
Mailing Address - Phone:765-720-6411
Mailing Address - Fax:
Practice Address - Street 1:1946 W US HIGHWAY 40
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135-8706
Practice Address - Country:US
Practice Address - Phone:765-653-8441
Practice Address - Fax:765-653-5936
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2015-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010600A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1632400OtherUNITED CONCORDIA
IN200461700Medicaid