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General NPI Number Information
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NPI Number | 1801872395
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Entity Type | Organization
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Legal Business Name | KIMBERLY A EBNER DDS INC
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Dates
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Enumeration Date | 12/16/2005
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Last Update Date | 10/25/2007
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Provider Practice Location Address
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Address Line | 1060 E GREEN STREET SUITE 105
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City | PASADENA
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State | CA
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Zip | 91106
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Country | US
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Telephone | 626-796-9246
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Fax | 626-564-8395
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Provider Business Mailing Address
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Address Line | 1060 E GREEN STREET SUITE 105
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City | PASADENA
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State | CA
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Zip | 91106
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Country | US
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Telephone | 626-796-9246
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Fax | 626-564-8395
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Authorized Official
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Title or Position | OWNER
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Name | DR. KIMBERLY ANN EBNER
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Credential | DDS
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Telephone | 626-796-9246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D37328
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License Number State | CA
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