Provider Demographics
NPI:1396889523
Name:KIMMELMAN, JUDITH ANNE (DMD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANNE
Last Name:KIMMELMAN
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 1:5 STONEY HILL LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-2903
Mailing Address - Country:US
Mailing Address - Phone:856-206-9480
Mailing Address - Fax:
Practice Address - Street 1:31 W MAIN ST
Practice Address - Street 2:
Practice Address - City:PENNS GROVE
Practice Address - State:NJ
Practice Address - Zip Code:08069-1348
Practice Address - Country:US
Practice Address - Phone:856-299-1096
Practice Address - Fax:856-299-4222
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0175201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice