Provider Demographics
NPI:1629343199
Name:FORNEY, KIMBERLY MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:MARIE
Last Name:FORNEY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:157 14TH ST
Mailing Address - Street 2:APT 4R
Mailing Address - City:HOBOKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07030-4449
Mailing Address - Country:US
Mailing Address - Phone:781-572-2851
Mailing Address - Fax:
Practice Address - Street 1:1216 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HOBOKEN
Practice Address - State:NJ
Practice Address - Zip Code:07030-5453
Practice Address - Country:US
Practice Address - Phone:201-386-8090
Practice Address - Fax:201-386-9082
Is Sole Proprietor?:No
Enumeration Date:2012-03-17
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI02550800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist