MEDICARE: KIMBERLY A ERDMAN RDH

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	124Q00000X	Dental Hygienist	PHDH000164	PA

General Provider Information

NPI Number	:	1790066066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY A ERDMAN RDH

Provider Business Mailing Address
First Line	:	8320 COLESVILLE RD
Second Line	:	APT 102
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-3303
Country	:	US
Telephone Number	:	570-847-2670
Fax Number	:

Provider Business Practice Location Address
First Line	:	915 N ST SE
Second Line	:	BUILDING 175
City	:	WASHINGTON NAVY YARD
State	:	DC
Zip	:	20374-5162
Country	:	US
Telephone Number	:	202-433-2480
Fax Number	:

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

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	08/31/2011

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