Provider Demographics
NPI:1588103840
Name:BAPTIST, KIMBERLY (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:
Last Name:BAPTIST
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 1:4055 LINDELL BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63108-3201
Mailing Address - Country:US
Mailing Address - Phone:314-535-7701
Mailing Address - Fax:314-535-0385
Practice Address - Street 1:4055 LINDELL BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-3201
Practice Address - Country:US
Practice Address - Phone:314-535-7701
Practice Address - Fax:314-535-0385
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-20
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2017000649122300000X
IL019030773122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist