Provider Demographics
NPI:1669552766
Name:HILL, KIMBERLY (DMD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:HILL
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 1:344 E ARCH ST
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-2102
Mailing Address - Country:US
Mailing Address - Phone:270-821-8172
Mailing Address - Fax:270-821-5593
Practice Address - Street 1:344 E ARCH ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-2102
Practice Address - Country:US
Practice Address - Phone:270-821-8172
Practice Address - Fax:270-821-5593
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60067360Medicaid