Provider Demographics
NPI:1740213339
Name:KIMERY, MILLARD JULIAN (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:MILLARD
Middle Name:JULIAN
Last Name:KIMERY
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W VETERANS BLVD
Mailing Address - Street 2:DENTAL CLINIC
Mailing Address - City:BIG SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:79720-5566
Mailing Address - Country:US
Mailing Address - Phone:800-472-1365
Mailing Address - Fax:
Practice Address - Street 1:300 W VETERANS BLVD
Practice Address - Street 2:DENTAL CLINIC
Practice Address - City:BIG SPRING
Practice Address - State:TX
Practice Address - Zip Code:79720-5566
Practice Address - Country:US
Practice Address - Phone:800-472-1365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX98641223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics