Healthcare Provider Details

I. General information

NPI: 1700363413
Provider Name (Legal Business Name): KIMBERLEY N ENGOLS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MERCY CIR
OCEANSIDE CA
92055
US

IV. Provider business mailing address

2610 FLOWER FIELDS WAY
CARLSBAD CA
92010-8330
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-4357
  • Fax:
Mailing address:
  • Phone: 520-255-3127
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number00203639
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: