Provider Demographics
NPI:1770642704
Name:STEVEN D KIMBERLEY DMD PC
Entity Type:Organization
Organization Name:STEVEN D KIMBERLEY DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KIMBERLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD PS
Authorized Official - Phone:360-733-7708
Mailing Address - Street 1:3300 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225
Mailing Address - Country:US
Mailing Address - Phone:360-733-7708
Mailing Address - Fax:360-733-9207
Practice Address - Street 1:3300 SQUALICUM PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225
Practice Address - Country:US
Practice Address - Phone:360-733-7708
Practice Address - Fax:360-733-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA55181223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty