Basic Information
| Provider Information | |||||||||
| NPI: | 1447760442 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TODD | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | MERLE | ||||||||
| NamePrefix: | |||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 7363 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985077363 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3602591030 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | S 14TH STREET AND RAILROAD AVENUE | ||||||||
| Address2: | BUILDING # 3740P | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539675271 | ||||||||
| FaxNumber: | 2539671273 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2017 | ||||||||
| LastUpdateDate: | 10/04/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | DH00004681 | WA | Y | Dental Providers | Dental Hygienist |
No ID Information.