Provider Demographics
NPI:1649419938
Name:DYOCO, KIMBERLY ANN I (DDS)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ANN
Last Name:DYOCO
Suffix:I
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 1:522 CHESTNUT ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:HINSDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60521-3173
Mailing Address - Country:US
Mailing Address - Phone:630-323-4468
Mailing Address - Fax:630-323-4446
Practice Address - Street 1:522 CHESTNUT ST STE 2A
Practice Address - Street 2:
Practice Address - City:HINSDALE
Practice Address - State:IL
Practice Address - Zip Code:60521-3173
Practice Address - Country:US
Practice Address - Phone:630-323-4468
Practice Address - Fax:630-323-4446
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027698122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist