Basic Information
| Provider Information | |||||||||
| NPI: | 1538578315 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHLAM | ||||||||
| FirstName: | KIMBERLY | ||||||||
| MiddleName: | KOCAK | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | USA DENTAL ACTIVITY | ||||||||
| Address2: | 6837 NORMANDY DRIVE | ||||||||
| City: | FORT BRAGG | ||||||||
| State: | AA | ||||||||
| PostalCode: | 28307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106432196 | ||||||||
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| Practice Location | |||||||||
| Address1: | USA DENTAL ACTIVITY | ||||||||
| Address2: | 6837 NORMANDY DRIVE ATTN:MCDS NA B | ||||||||
| City: | APO | ||||||||
| State: | AA | ||||||||
| PostalCode: | 28307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9106432196 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/06/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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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 | 1223G0001X | 9845 | NC | N | Dental Providers | Dentist | General Practice | 1223P0700X | 9845 | NC | Y | Dental Providers | Dentist | Prosthodontics |
No ID Information.