Healthcare Provider Details

I. General information

NPI: 1164612123
Provider Name (Legal Business Name): KIMBERLY D BRITT DENTAL ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIM D RICHARDSON

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 10/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG N-46 CAPE SARICHEF
KODIAK AK
99619-5002
US

IV. Provider business mailing address

BLDG N-46
KODIAK AK
99619-5002
US

V. Phone/Fax

Practice location:
  • Phone: 907-487-5757
  • Fax:
Mailing address:
  • Phone: 907-487-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: