Provider Demographics
NPI:1154408722
Name:MEDLIN, KIMLEA SARA (DDS)
Entity type:Individual
Prefix:
First Name:KIMLEA
Middle Name:SARA
Last Name:MEDLIN
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 1:1296 AGVIK ST
Mailing Address - Street 2:PO BOX 29
Mailing Address - City:BARROW
Mailing Address - State:AK
Mailing Address - Zip Code:99723
Mailing Address - Country:US
Mailing Address - Phone:907-852-9221
Mailing Address - Fax:907-852-9297
Practice Address - Street 1:1296 AGVIK ST
Practice Address - Street 2:
Practice Address - City:BARROW
Practice Address - State:AK
Practice Address - Zip Code:99723
Practice Address - Country:US
Practice Address - Phone:907-852-9221
Practice Address - Fax:907-852-9297
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9244122300000X
AK1217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist