Provider Demographics
NPI:1841720406
Name:POLLEY, KIMBERLY (DDS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:POLLEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:BARTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:3811 N 167TH CT
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68116-8067
Mailing Address - Country:US
Mailing Address - Phone:402-991-6965
Mailing Address - Fax:
Practice Address - Street 1:3811 N 167TH CT
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68116-8067
Practice Address - Country:US
Practice Address - Phone:402-991-6965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE73621223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE7362OtherDENTAL LICENSE
FB7127334OtherDEA