Provider Demographics
NPI:1063716678
Name:MOWERY, KIMBERLEY BROOKE (DMD)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLEY
Middle Name:BROOKE
Last Name:MOWERY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4960 NEWBERRY ROAD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607
Mailing Address - Country:US
Mailing Address - Phone:352-332-6725
Mailing Address - Fax:352-372-1717
Practice Address - Street 1:4960 NEWBERRY ROAD
Practice Address - Street 2:SUITE 220
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607
Practice Address - Country:US
Practice Address - Phone:352-332-6725
Practice Address - Fax:352-332-6725
Is Sole Proprietor?:No
Enumeration Date:2010-12-23
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN159021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice