Individual
KIMBERLEY BARANOWSKI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
101 SHELDON BLVD SE, GRAND RAPIDS, MI 49503-4262
(616) 776-2340
Mailing address
101 SHELDON BLVD SE, GRAND RAPIDS, MI 49503-4262
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902009418
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2902009418
—
MI
Enumeration date
12/01/2015
Last updated
12/01/2015
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