Provider Demographics
NPI:1902918444
Name:MINOR, KIMBERLY JOI (DDS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOI
Last Name:MINOR
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 1:4901 N TRYON ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-7033
Mailing Address - Country:US
Mailing Address - Phone:704-921-0204
Mailing Address - Fax:704-921-4095
Practice Address - Street 1:4901 N TRYON ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-7033
Practice Address - Country:US
Practice Address - Phone:704-921-0204
Practice Address - Fax:704-921-4095
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC76391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice