| NPI | 1811965593 |
|---|---|
| Former Name | KIMBERLY NICHOLE LEEDS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1223P0221X Dentist, Pediatric Dentistry (Licence: OR D10197) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice (Licence: TX 21299) |
| 1223P0221X Dentist, Pediatric Dentistry (Licence: WA DE60088337) | |
| Enumeration Date | 2006-03-09 |
| Last Update Date | 2020-02-25 |