Provider Demographics
NPI:1942213673
Name:MEYER, KIMBERLY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:MEYER
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:PO BOX 238
Mailing Address - Street 2:
Mailing Address - City:WEST NOTTINGHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03291-0238
Mailing Address - Country:US
Mailing Address - Phone:603-942-8000
Mailing Address - Fax:603-942-8047
Practice Address - Street 1:24 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:NORTHWOOD
Practice Address - State:NH
Practice Address - Zip Code:03261
Practice Address - Country:US
Practice Address - Phone:603-942-8000
Practice Address - Fax:603-942-8047
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH30871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30302511Medicaid