Provider Demographics
NPI:1295866291
Name:VERTICHIO, KIMBERLY KAY (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:KAY
Last Name:VERTICHIO
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 1:57 SHAW AVE
Mailing Address - Street 2:
Mailing Address - City:BELLPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11713-2042
Mailing Address - Country:US
Mailing Address - Phone:631-803-2650
Mailing Address - Fax:
Practice Address - Street 1:33 STATION RD
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-2443
Practice Address - Country:US
Practice Address - Phone:631-286-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0485741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice