Provider Demographics
NPI:1932335635
Name:HERRMANN, KIMBERLY JUSTINE (RDH)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:JUSTINE
Last Name:HERRMANN
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 1:50 52ND ST
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-4519
Mailing Address - Country:US
Mailing Address - Phone:228-365-4488
Mailing Address - Fax:866-905-4316
Practice Address - Street 1:2574 MARCIA CT
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2341
Practice Address - Country:US
Practice Address - Phone:228-388-9545
Practice Address - Fax:228-385-1161
Is Sole Proprietor?:No
Enumeration Date:2009-06-08
Last Update Date:2009-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2152-86DH124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist