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General NPI Number Information
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NPI Number | 1548466774
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Entity Type | Organization
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Legal Business Name | DENISE KIMACK DMD PC
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10000 WATSON ROAD SUITE D
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City | ST LOUIS
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State | MO
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Zip | 63126
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Country | US
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Telephone | 314-821-3191
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Fax | 314-821-1304
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Provider Business Mailing Address
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Address Line | 10000 WATSON ROAD SUITE D
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City | ST LOUIS
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State | MO
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Zip | 63126
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Country | US
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Telephone | 314-821-3191
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Fax | 314-821-1304
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DENISE L KIMACK
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Credential | DMD
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Telephone | 314-821-3191
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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 | 15426
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License Number State | MO
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