Provider Demographics
NPI:1205960309
Name:CANTON-KANE, KIMBERLEY (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLEY
Middle Name:
Last Name:CANTON-KANE
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 1:280 CONCORD PKWY S STE 110A
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28027-2704
Mailing Address - Country:US
Mailing Address - Phone:704-920-1070
Mailing Address - Fax:704-934-4270
Practice Address - Street 1:280 CONCORD PKWY S STE 110A
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28027-2704
Practice Address - Country:US
Practice Address - Phone:704-920-1070
Practice Address - Fax:704-920-1071
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC9021HOtherBCBS
1205960309OtherNPI