| NPI | 1083640007 |
|---|---|
| Former Name | MARY KATHLEEN KIMBALL |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: ID 9161076) |
| Additional Taxonomies | 122300000X Dentist (Licence: OR D7115) |
| 1223G0001X Dentist General Practice (Licence: OR D7115) | |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2025-07-14 |