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General NPI Number Information
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NPI Number | 1376113555
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Entity Type | Individual
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Provider Name | KIMBERLY MARION BARBOUR DDS
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Gender | Female
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Dates
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Enumeration Date | 06/29/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 312 CROCKER BLVD
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City | MOUNT CLEMENS
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State | MI
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Zip | 48043-2547
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Country | US
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Telephone | 586-469-6336
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Fax |
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Provider Business Mailing Address
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Address Line | 58 CRANFORD LN
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City | GROSSE POINTE
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State | MI
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Zip | 48230-1546
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Country | US
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Telephone | 313-949-6424
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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 | 2901601061
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License Number State | MI
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