MEDICARE: DR. JUDITH ANNE KIMMELMAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DI017520	NJ

General Provider Information

NPI Number	:	1396889523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH ANNE KIMMELMAN D.M.D.

Provider Business Mailing Address
First Line	:	5 STONEY HILL LN
Second Line	:
City	:	MOUNT LAUREL
State	:	NJ
Zip	:	08054-2903
Country	:	US
Telephone Number	:	856-206-9480
Fax Number	:

Provider Business Practice Location Address
First Line	:	31 W MAIN ST
Second Line	:
City	:	PENNS GROVE
State	:	NJ
Zip	:	08069-1348
Country	:	US
Telephone Number	:	856-299-1096
Fax Number	:	856-299-4222

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	06/17/2013

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