Healthcare Provider Details

I. General information

NPI: 1225231418
Provider Name (Legal Business Name): PATRICIA J KIMES DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 12/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11420 BEE CAVES RD SUITE B-150
AUSTIN TX
78738-5526
US

IV. Provider business mailing address

11420 BEE CAVES RD SUITE B-150
AUSTIN TX
78738-5526
US

V. Phone/Fax

Practice location:
  • Phone: 512-263-8500
  • Fax: 512-263-2866
Mailing address:
  • Phone: 512-263-8500
  • Fax: 512-263-2866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number0023285
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: