Provider Demographics
NPI:1619506540
Name:FREELS, KIMBERLEY RENEE' (RDHAP)
Entity Type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:RENEE'
Last Name:FREELS
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9530 HAGEMAN RD # B232
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-3959
Mailing Address - Country:US
Mailing Address - Phone:661-549-2927
Mailing Address - Fax:
Practice Address - Street 1:9623 PRADO DEL REY DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93314-8561
Practice Address - Country:US
Practice Address - Phone:661-549-2927
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP740124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist