Provider Demographics
NPI:1134274335
Name:CRAVEN, KIMBERLY RICHARDS (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RICHARDS
Last Name:CRAVEN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6309 S AUER ST
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99223-8331
Mailing Address - Country:US
Mailing Address - Phone:509-951-7622
Mailing Address - Fax:
Practice Address - Street 1:1424 S BERNARD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2154
Practice Address - Country:US
Practice Address - Phone:509-747-7166
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-25
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00010773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1003288Medicaid