Healthcare Provider Details

I. General information

NPI: 1912274903
Provider Name (Legal Business Name): KIMBERLEE CURRY-MIKULAK RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2011
Last Update Date: 11/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BDENTAC UNIT 28130 GRAFENWOEHR
APO AE
09114
US

IV. Provider business mailing address

CMR 415 BOX 4387
APO AE
09114-0044
US

V. Phone/Fax

Practice location:
  • Phone: 09641831720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberH7455
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: