Healthcare Provider Details

I. General information

NPI: 1184061004
Provider Name (Legal Business Name): KIMBERLY RIVERA GRESS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2013
Last Update Date: 05/29/2026
Certification Date: 05/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25612 CROWN VALLEY PKWY STE L7
LADERA RANCH CA
92694-0476
US

IV. Provider business mailing address

2262 SHATTO LN
TUSTIN CA
92782-1461
US

V. Phone/Fax

Practice location:
  • Phone: 949-347-0800
  • Fax:
Mailing address:
  • Phone: 949-677-7530
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number50178
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: