Provider Demographics
NPI:1104995893
Name:RIOUX, KIMBERLY JENSEN (DDS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JENSEN
Last Name:RIOUX
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 1:3519 56TH ST NW
Mailing Address - Street 2:STE 260
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335
Mailing Address - Country:US
Mailing Address - Phone:253-857-6778
Mailing Address - Fax:253-857-1030
Practice Address - Street 1:3519 56TH ST NW
Practice Address - Street 2:STE 260
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335
Practice Address - Country:US
Practice Address - Phone:253-857-6778
Practice Address - Fax:253-857-1030
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA85491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice