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General NPI Number Information
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NPI Number | 1104928738
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Entity Type | Individual
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Provider Name | KIMBERLY S HANSFORD DMD
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Gender | Female
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Dates
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Enumeration Date | 09/03/2006
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Last Update Date | 09/21/2012
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Provider Practice Location Address
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Address Line | 130 EVERGREEN RD SUITE 100
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City | MIDDLETOWN
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State | KY
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Zip | 40243-1489
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Country | US
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Telephone | 502-410-1710
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Fax | 502-244-1244
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Provider Business Mailing Address
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Address Line | 130 EVERGREEN RD SUITE 100
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City | MIDDLETOWN
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State | KY
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Zip | 40243-1489
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Country | US
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Telephone | 502-410-1710
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Fax | 502-245-5021
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7469
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7469
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License Number State | KY
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