MEDICARE: DR. KEVIN CHRISTOPHER WIMAN DMD

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	DN27643	FL

General Provider Information

NPI Number	:	1811303183
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN CHRISTOPHER WIMAN DMD

Provider Business Mailing Address
First Line	:	8823 GOODBYS EXECUTIVE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4605
Country	:	US
Telephone Number	:	904-731-0432
Fax Number	:

Provider Business Practice Location Address
First Line	:	8823 GOODBYS EXECUTIVE DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4605
Country	:	US
Telephone Number	:	470-336-2612
Fax Number	:

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

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	03/06/2026

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