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General NPI Number Information
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NPI Number | 1558712398
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Entity Type | Organization
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Legal Business Name | KINBERLY ANTRIM DDS DENTAL CORPORATION
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 06/23/2016
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Provider Practice Location Address
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Address Line | 7880 WREN AVE SUITE A-113
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City | GILROY
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State | CA
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Zip | 95020-4943
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Country | US
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Telephone | 408-375-2155
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Fax |
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Provider Business Mailing Address
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Address Line | 7880 WREN AVE SUITE A-113
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City | GILROY
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State | CA
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Zip | 95020-4943
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Country | US
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Telephone | 408-375-2155
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. KINBERLY ANTRIM
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Credential | D.D.S.
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Telephone | 408-375-2155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 59694
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License Number State | CA
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