Provider Demographics
NPI:1780868174
Name:KIMBERLY S. CHRISTMAN DDS PA
Entity Type:Organization
Organization Name:KIMBERLY S. CHRISTMAN DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARLA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-895-3775
Mailing Address - Street 1:17824 STATESVILLE RD
Mailing Address - Street 2:SUITE 111
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-7130
Mailing Address - Country:US
Mailing Address - Phone:704-895-3775
Mailing Address - Fax:704-895-3770
Practice Address - Street 1:17824 STATESVILLE RD
Practice Address - Street 2:SUITE 111
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-7130
Practice Address - Country:US
Practice Address - Phone:704-895-3775
Practice Address - Fax:704-895-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-21
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty