Provider Demographics
NPI:1649488636
Name:STAMPIEN, KIMBERLY RENE (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:RENE
Last Name:STAMPIEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 PITTSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SCRANTON
Mailing Address - State:PA
Mailing Address - Zip Code:18505-4103
Mailing Address - Country:US
Mailing Address - Phone:570-346-1357
Mailing Address - Fax:570-346-3826
Practice Address - Street 1:732 PITTSTON AVE
Practice Address - Street 2:
Practice Address - City:SCRANTON
Practice Address - State:PA
Practice Address - Zip Code:18505-4103
Practice Address - Country:US
Practice Address - Phone:570-346-1357
Practice Address - Fax:570-346-3826
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS028588L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice