Provider Demographics
NPI:1902928245
Name:BRESLIN, KIMBERLY LAYNE (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:LAYNE
Last Name:BRESLIN
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 1:9800 SHELBYVILLE RD
Mailing Address - Street 2:STE 106
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40223-2977
Mailing Address - Country:US
Mailing Address - Phone:502-429-9945
Mailing Address - Fax:502-429-9947
Practice Address - Street 1:9800 SHELBYVILLE RD
Practice Address - Street 2:STE 106
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40223-2977
Practice Address - Country:US
Practice Address - Phone:502-429-9945
Practice Address - Fax:502-429-9947
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice