Provider Demographics
NPI:1306264684
Name:LEWIS, KIMBERLY PARKER (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:PARKER
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:7402 HIGHWAY 69 S STE H
Mailing Address - Street 2:
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35405-1301
Mailing Address - Country:US
Mailing Address - Phone:205-722-7550
Mailing Address - Fax:
Practice Address - Street 1:7402 HIGHWAY 69 S STE H
Practice Address - Street 2:
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35405-1301
Practice Address - Country:US
Practice Address - Phone:205-722-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-02
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL60391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice