Healthcare Provider Details

I. General information

NPI: 1396889523
Provider Name (Legal Business Name): JUDITH ANNE KIMMELMAN D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 W MAIN ST
PENNS GROVE NJ
08069-1348
US

IV. Provider business mailing address

5 STONEY HILL LN
MOUNT LAUREL NJ
08054-2903
US

V. Phone/Fax

Practice location:
  • Phone: 856-299-1096
  • Fax: 856-299-4222
Mailing address:
  • Phone: 856-206-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDI017520
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: