Provider Demographics
NPI:1134222631
Name:MARR, KAMI L (DDS)
Entity type:Individual
Prefix:DR
First Name:KAMI
Middle Name:L
Last Name:MARR
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KAMI
Other - Middle Name:L
Other - Last Name:WIMMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1813 61ST AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-8059
Mailing Address - Country:US
Mailing Address - Phone:970-356-2605
Mailing Address - Fax:970-304-6804
Practice Address - Street 1:1813 61ST AVE STE 100
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-8059
Practice Address - Country:US
Practice Address - Phone:970-356-2605
Practice Address - Fax:970-304-6804
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119071223G0001X
CO93491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9349OtherNO LONGER ACCEPT MEDICAID
CO9349OtherWE NO LONGER ACCEPT MEDICAID