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General NPI Number Information
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NPI Number | 1821024522
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Entity Type | Organization
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Legal Business Name | KIMBERLY A. DETTORI, D.D.S., M.S., P.A.
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Dates
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Enumeration Date | 06/24/2006
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Last Update Date | 03/18/2016
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Provider Practice Location Address
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Address Line | 903 SE OCEAN BLVD SUITE 1
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City | STUART
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State | FL
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Zip | 34994-2475
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Country | US
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Telephone | 772-221-3700
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Fax | 772-221-9107
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Provider Business Mailing Address
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Address Line | 903 SE OCEAN BLVD SUITE 1
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City | STUART
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State | FL
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Zip | 34994-2475
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Country | US
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Telephone | 772-221-3700
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Fax | 772-221-9107
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. KIMBERLY A DETTORI
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Credential | D.D.S., M.S.
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Telephone | 772-221-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | DN12143
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License Number State | FL
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