Provider Demographics
NPI:1891026068
Name:SCHIAVONE, KIM B (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:B
Last Name:SCHIAVONE
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 1:2300 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-5302
Mailing Address - Country:US
Mailing Address - Phone:502-778-8354
Mailing Address - Fax:502-776-3136
Practice Address - Street 1:2300 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40216-5302
Practice Address - Country:US
Practice Address - Phone:502-778-8354
Practice Address - Fax:502-776-3136
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-27
Last Update Date:2010-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY62541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice