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General NPI Number Information
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NPI Number | 1326001801
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Entity Type | Individual
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Provider Name | KIMBERLY T. LOUGH DDS, MS
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Gender | Female
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Dates
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Enumeration Date | 04/07/2006
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Last Update Date | 01/15/2013
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Provider Practice Location Address
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Address Line | 12 KANAWHA TER SUITE B
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2750
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Country | US
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Telephone | 304-722-7221
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Fax | 304-722-0420
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Provider Business Mailing Address
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Address Line | 12 KANAWHA TER SUITE B
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City | SAINT ALBANS
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State | WV
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Zip | 25177-2750
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Country | US
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Telephone | 304-722-7221
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Fax | 304-722-0420
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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 | 3415
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License Number State | WV
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