Provider Demographics
NPI:1790883585
Name:SERVAGNO, KIMBERLY LAND (DMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LAND
Last Name:SERVAGNO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1610 E EMMAUS AVE
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-8307
Mailing Address - Country:US
Mailing Address - Phone:610-799-7626
Mailing Address - Fax:610-799-7691
Practice Address - Street 1:1610 E EMMAUS AVE
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-8307
Practice Address - Country:US
Practice Address - Phone:610-799-7626
Practice Address - Fax:610-799-7691
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027326L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist