Basic Information
| Provider Information | |||||||||
| NPI: | 1538343421 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MOORE | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | ANN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8248 PLANTATION MANOR BUILDING 53 PAPAYA | ||||||||
| Address2: | |||||||||
| City: | ST. THOMAS | ||||||||
| State: | VI | ||||||||
| PostalCode: | 00802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613461027 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 100 LAKE TRAVERSE DR | ||||||||
| Address2: | |||||||||
| City: | SISSETON | ||||||||
| State: | SD | ||||||||
| PostalCode: | 572627046 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6056987606 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2007 | ||||||||
| LastUpdateDate: | 03/21/2019 | ||||||||
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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 | 122300000X | 917 | VI | Y | Dental Providers | Dentist |
No ID Information.