MEDICARE: KIMBERLY DAWN NEIMAN 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	1223G0001X	General Practice Dentistry	16376	TX

General Provider Information

NPI Number	:	1942369756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DAWN NEIMAN DDS

Provider Business Mailing Address
First Line	:	217 N 4TH ST
Second Line	:
City	:	WILLS POINT
State	:	TX
Zip	:	75169-2042
Country	:	US
Telephone Number	:	903-873-4102
Fax Number	:	903-873-4154

Provider Business Practice Location Address
First Line	:	217 N 4TH ST
Second Line	:
City	:	WILLS POINT
State	:	TX
Zip	:	75169-2042
Country	:	US
Telephone Number	:	903-873-4102
Fax Number	:	903-873-4154

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

Provider Enumeration Date	:	12/07/2006
Last Update Date	:	07/08/2007

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