Provider Demographics
NPI:1285104091
Name:DENNIS, KIMBERLY ROSE (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ROSE
Last Name:DENNIS
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 1:1902 SW 106TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32607-6710
Mailing Address - Country:US
Mailing Address - Phone:352-318-2330
Mailing Address - Fax:
Practice Address - Street 1:145 N NOVA RD
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5138
Practice Address - Country:US
Practice Address - Phone:386-677-1046
Practice Address - Fax:386-672-6741
Is Sole Proprietor?:No
Enumeration Date:2018-12-05
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN212541223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics