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NPI Code Detail

MEDICARE: DR. KIM E DIEFENDERFER DMD, MS, MS

MEDICARE: DR. KIM E DIEFENDERFER DMD, MS, MS
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
11223G0001XGeneral Practice Dentistry12012261AIN
21223G0001XGeneral Practice DentistryDS027331LPA

General Provider Information

NPI Number : 1932172459
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KIM E DIEFENDERFER DMD, MS, MS
Provider Business Mailing Address
First Line : 2728 STILL CREEK DR
Second Line :
City : ZIONSVILLE
State : IN
Zip : 46077-1195
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1121 W MICHIGAN ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-5211
Country : US
Telephone Number : 172-743-7153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2006
Last Update Date : 11/08/2021

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