Provider Demographics
NPI:1306056502
Name:RAO, KIMBERLY SHARON (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:SHARON
Last Name:RAO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:SHARON
Other - Last Name:GHALI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1137 E SANDPIPER DR
Mailing Address - Street 2:UNIT 101
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-2072
Mailing Address - Country:US
Mailing Address - Phone:480-491-0267
Mailing Address - Fax:
Practice Address - Street 1:4830 E MAIN ST # B-7
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-8003
Practice Address - Country:US
Practice Address - Phone:480-832-3335
Practice Address - Fax:480-832-4898
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD70491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice