Basic Information
| Provider Information | |||||||||
| NPI: | 1356836936 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MAHONEY | ||||||||
| FirstName: | KIMBERLEY | ||||||||
| MiddleName: | JOELL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 S ULSTER ST UNIT 308 | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802312770 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3477813644 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3414 CHURCH AVE | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112032714 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186302197 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2018 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DEN.00203959 | CO | Y | Dental Providers | Dentist | General Practice |
No ID Information.