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General NPI Number Information
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NPI Number | 1619051828
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Entity Type | Individual
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Provider Name | KIMBERLY WEYNETH D.D.S.
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 152 N ADDISON AVE SUITE 201
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City | ELMHURST
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State | IL
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Zip | 60126-2810
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Country | US
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Telephone | 630-530-8852
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Fax | 630-530-8861
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Provider Business Mailing Address
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Address Line | 11115 GLENBROOK LN
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City | INDIANHEAD PARK
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State | IL
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Zip | 60525-6984
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Country | US
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Telephone | 708-246-2889
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | IL
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