| NPI | 1952743429 |
|---|---|
| Former Name | KIMBERLY JEAN ROBERTS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 122300000X Dentist (Licence: KY 9358) |
| Additional Taxonomies | 122300000X Dentist (Licence: SC DGD.8267 GD) |
| Enumeration Date | 2013-07-24 |
| Last Update Date | 2017-01-18 |