Provider Demographics
NPI:1730349705
Name:COLE, KIMBERLY HERRIN (DMD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:HERRIN
Last Name:COLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:WILLINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3621 RIVERCREST RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9400
Mailing Address - Country:US
Mailing Address - Phone:706-855-5993
Mailing Address - Fax:
Practice Address - Street 1:100 MYRTLE BLVD
Practice Address - Street 2:
Practice Address - City:GRACEWOOD
Practice Address - State:GA
Practice Address - Zip Code:30812
Practice Address - Country:US
Practice Address - Phone:706-790-2144
Practice Address - Fax:706-790-2326
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-13
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA10897122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist