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General NPI Number Information
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NPI Number | 1285289777
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Entity Type | Individual
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Provider Name | KIMBERLY ELIZABETH BAUMGARDNER DMD
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Gender | Female
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Dates
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Enumeration Date | 08/02/2019
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Last Update Date | 09/24/2024
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Provider Practice Location Address
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Address Line | 2410 NW FEDERAL HWY STE A110
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City | STUART
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State | FL
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Zip | 34994-9314
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Country | US
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Telephone | 772-692-4002
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Fax |
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Provider Business Mailing Address
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Address Line | 10871 HAYDN DR
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City | BOCA RATON
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State | FL
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Zip | 33498-6749
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Country | US
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Telephone | 619-972-8708
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.025864
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN28789
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License Number State | FL
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