MEDICARE: MISS KIMBERLY MARIE ANDERSON DDS

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	122300000X	Dentist	16896	OH

General Provider Information

NPI Number	:	1750471165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KIMBERLY MARIE ANDERSON DDS

Provider Business Mailing Address
First Line	:	7100 SENNET PLACE
Second Line	:	SUITE E
City	:	WEST CHESTER
State	:	OH
Zip	:	45069
Country	:	US
Telephone Number	:	513-759-5481
Fax Number	:	513-759-5612

Provider Business Practice Location Address
First Line	:	7100 SENNET PLACE
Second Line	:	SUITE E
City	:	WEST CHESTER
State	:	OH
Zip	:	45069
Country	:	US
Telephone Number	:	513-759-5481
Fax Number	:	513-759-5612

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

Provider Enumeration Date	:	10/14/2006
Last Update Date	:	07/08/2007

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