Provider Demographics
NPI:1972601276
Name:STOPAR WORTON, KIMBERLY R (DDS)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:R
Last Name:STOPAR WORTON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6363 YORK ROAD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:PARMA HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-3031
Mailing Address - Country:US
Mailing Address - Phone:440-885-5354
Mailing Address - Fax:440-888-5112
Practice Address - Street 1:6363 YORK ROAD
Practice Address - Street 2:SUITE 203
Practice Address - City:PARMA HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44130-3031
Practice Address - Country:US
Practice Address - Phone:440-885-5354
Practice Address - Fax:440-888-5112
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice