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General NPI Number Information
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NPI Number | 1730255753
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Entity Type | Organization
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Legal Business Name | R KIMBLE DOTY, JR DDS,MS PEDIATRIC DENTISTRY, PC
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1119 42ND AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2664
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Country | US
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Telephone | 228-864-8521
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Fax | 228-863-8992
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Provider Business Mailing Address
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Address Line | 1119 42ND AVE
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City | GULFPORT
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State | MS
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Zip | 39501-2664
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Country | US
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Telephone | 228-864-8521
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Fax | 228-863-8992
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Authorized Official
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Title or Position | PRESIDENT
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Name | R KIMBLE DOTY
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Credential | D.D.S., M.S.
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Telephone | 228-864-8521
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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 | 2922
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License Number State | MS
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