Provider Demographics
NPI:1447760442
Name:TODD, KIMBERLY MERLE (RDH)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MERLE
Last Name:TODD
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7363
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98507-7363
Mailing Address - Country:US
Mailing Address - Phone:360-259-1030
Mailing Address - Fax:
Practice Address - Street 1:S 14TH STREET AND RAILROAD AVENUE
Practice Address - Street 2:BUILDING # 3740P
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98433
Practice Address - Country:US
Practice Address - Phone:253-967-5271
Practice Address - Fax:253-967-1273
Is Sole Proprietor?:No
Enumeration Date:2017-10-04
Last Update Date:2017-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00004681124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist