Provider Demographics
NPI:1720171069
Name:COORE, KIMBERLY SHARRELL (RDH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:SHARRELL
Last Name:COORE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 DEER NECK DR
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23323-7101
Mailing Address - Country:US
Mailing Address - Phone:757-753-2444
Mailing Address - Fax:
Practice Address - Street 1:USS NASSAU LHA 4
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:UNITED STATES
Practice Address - Zip Code:AE
Practice Address - Country:US
Practice Address - Phone:757-434-4864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7481124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist