Provider Demographics
NPI:1720500606
Name:DEAN, KIMBERLY DO (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DO
Last Name:DEAN
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 1:101 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2543
Mailing Address - Country:US
Mailing Address - Phone:205-240-1269
Mailing Address - Fax:
Practice Address - Street 1:101 E 1ST ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2543
Practice Address - Country:US
Practice Address - Phone:256-245-5635
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-12
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL6590-C11223G0001X
WADE60755132122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist