Healthcare Provider Details

I. General information

NPI: 1790066066
Provider Name (Legal Business Name): KIMBERLY A ERDMAN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 08/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 N ST SE BUILDING 175
WASHINGTON NAVY YARD DC
20374-5162
US

IV. Provider business mailing address

8320 COLESVILLE RD APT 102
SILVER SPRING MD
20910-3303
US

V. Phone/Fax

Practice location:
  • Phone: 202-433-2480
  • Fax:
Mailing address:
  • Phone: 570-847-2670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberPHDH000164
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: