Provider Demographics
NPI:1891816310
Name:WASS, KIMBERLY J
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:J
Last Name:WASS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:707 5TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-5979
Mailing Address - Country:US
Mailing Address - Phone:515-232-2152
Mailing Address - Fax:515-232-2153
Practice Address - Street 1:707 5TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-5979
Practice Address - Country:US
Practice Address - Phone:515-232-2152
Practice Address - Fax:515-232-2153
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA68121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics