Provider Demographics
NPI:1447452552
Name:BRANHAM, KIMBERLY LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LYNN
Last Name:BRANHAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23700 ORCHARD LAKE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-2559
Mailing Address - Country:US
Mailing Address - Phone:248-474-5572
Mailing Address - Fax:
Practice Address - Street 1:23700 ORCHARD LAKE RD
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-2559
Practice Address - Country:US
Practice Address - Phone:248-474-5572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010196011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice