Provider Demographics
NPI:1790066066
Name:ERDMAN, KIMBERLY A (RDH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:ERDMAN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8320 COLESVILLE RD
Mailing Address - Street 2:APT 102
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3303
Mailing Address - Country:US
Mailing Address - Phone:570-847-2670
Mailing Address - Fax:
Practice Address - Street 1:915 N ST SE
Practice Address - Street 2:BUILDING 175
Practice Address - City:WASHINGTON NAVY YARD
Practice Address - State:DC
Practice Address - Zip Code:20374-5162
Practice Address - Country:US
Practice Address - Phone:202-433-2480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPHDH000164124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist