Provider Demographics
NPI:1962500736
Name:BURDEN, KIMBERLY JO (DMD)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JO
Last Name:BURDEN
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 1:112 MCMURTRY AVE
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347
Mailing Address - Country:US
Mailing Address - Phone:270-298-7696
Mailing Address - Fax:270-298-7697
Practice Address - Street 1:112 MCMURTRY AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347
Practice Address - Country:US
Practice Address - Phone:270-298-7696
Practice Address - Fax:270-298-7697
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
KY5797122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist