Provider Demographics
NPI:1124695283
Name:WINBORN, KIMBERLY PUGH (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:PUGH
Last Name:WINBORN
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 1:6760 AQUILA CIR W
Mailing Address - Street 2:
Mailing Address - City:OLIVE BRANCH
Mailing Address - State:MS
Mailing Address - Zip Code:38654-7824
Mailing Address - Country:US
Mailing Address - Phone:228-861-4222
Mailing Address - Fax:
Practice Address - Street 1:730 COULTER DR
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-2807
Practice Address - Country:US
Practice Address - Phone:662-534-4397
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4209-211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice