Healthcare Provider Details

I. General information

NPI: 1154999720
Provider Name (Legal Business Name): KIMBERLY SCHAAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2021
Last Update Date: 06/11/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21444 CARMEAN WAY
GEORGETOWN DE
19947-4572
US

IV. Provider business mailing address

22697 HOLLY WAY W
LEWES DE
19958-5264
US

V. Phone/Fax

Practice location:
  • Phone: 302-855-1233
  • Fax:
Mailing address:
  • Phone: 302-357-6447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberG2-0003064
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: