Provider Demographics
NPI:1699816991
Name:NIEMOELLER, KIM SUE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:SUE
Last Name:NIEMOELLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:SUE
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:306 LIMESTONE RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19363
Mailing Address - Country:US
Mailing Address - Phone:610-932-9580
Mailing Address - Fax:610-932-3852
Practice Address - Street 1:306 LIMESTONE RD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:PA
Practice Address - Zip Code:19363
Practice Address - Country:US
Practice Address - Phone:610-932-9580
Practice Address - Fax:610-932-3852
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS026461L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist