Provider Demographics
NPI:1811408446
Name:FICHTHORN, KIMBERLY MORGAN (RDH, IPDH)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MORGAN
Last Name:FICHTHORN
Suffix:
Gender:F
Credentials:RDH, IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 MAIN ST STE C
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:ME
Mailing Address - Zip Code:04364-1491
Mailing Address - Country:US
Mailing Address - Phone:207-930-0833
Mailing Address - Fax:
Practice Address - Street 1:168 MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:ME
Practice Address - Zip Code:04364
Practice Address - Country:US
Practice Address - Phone:207-930-0833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-23
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4109124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist