Provider Demographics
NPI:1124257001
Name:ANTRIM, KINBERLY (DDS)
Entity type:Individual
Prefix:DR
First Name:KINBERLY
Middle Name:
Last Name:ANTRIM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:ANTRIM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:7880 WREN AVE STE B125
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7801
Mailing Address - Country:US
Mailing Address - Phone:408-842-2818
Mailing Address - Fax:
Practice Address - Street 1:7880 WREN AVE STE B125
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7801
Practice Address - Country:US
Practice Address - Phone:408-842-2818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice