Provider Demographics
NPI:1013075902
Name:KIMSEY, RAYMOND DANIEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:DANIEL
Last Name:KIMSEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3228 PONCE DE LEON BLVD
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-7239
Mailing Address - Country:US
Mailing Address - Phone:305-444-7345
Mailing Address - Fax:
Practice Address - Street 1:3228 PONCE DE LEON BLVD
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-7239
Practice Address - Country:US
Practice Address - Phone:305-444-7345
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9650122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist