Healthcare Provider Details

I. General information

NPI: 1346240561
Provider Name (Legal Business Name): KIMBERLY DAWN SCOTT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY D SCOTT D.D.S.

II. Dates (important events)

Enumeration Date: 07/29/2005
Last Update Date: 08/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 KIMEL PARK DR STE 202
WINSTON SALEM NC
27103-6973
US

IV. Provider business mailing address

2408 WATERWHEEL DR
WINSTON SALEM NC
27103-6475
US

V. Phone/Fax

Practice location:
  • Phone: 336-659-9500
  • Fax: 615-714-1017
Mailing address:
  • Phone: 615-210-8430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number7417
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8628
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: