Provider Demographics
NPI:1881938850
Name:HANNAH-JONES, KIMBERLY L (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:L
Last Name:HANNAH-JONES
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 1:11213 N NEBRASKA AVE
Mailing Address - Street 2:SUITE 406C
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33612-5775
Mailing Address - Country:US
Mailing Address - Phone:813-977-4819
Mailing Address - Fax:813-977-4568
Practice Address - Street 1:11213 N NEBRASKA AVE
Practice Address - Street 2:SUITE 406C
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33612-5775
Practice Address - Country:US
Practice Address - Phone:813-977-4819
Practice Address - Fax:813-977-4568
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0012708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL073523001Medicaid