MEDICARE: KIMBERLY PHELPS DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN 19933	FL

General Provider Information

NPI Number	:	1598013401
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY PHELPS DMD

Provider Business Mailing Address
First Line	:	7810 BROADSTONE LOOP
Second Line	:	APT 103
City	:	TAMPA
State	:	FL
Zip	:	33625-2456
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12813 N DALE MABRY HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33618-2803
Country	:	US
Telephone Number	:	813-962-1400
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	08/27/2012

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Directions to “ KIMBERLY PHELPS DMD” Practice Location

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