Individual
DR. NICOLE SUZETTE KIMMES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
716 STEVENS AVE, PORTLAND, ME 04103
(207) 221-4739
(207) 523-1915
Mailing address
716 STEVENS AVE, PORTLAND, ME 04103-2693
(207) 221-4739
(207) 523-1915
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DEN4481
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47071268413
—
NE
01
—
7997
BCBS PROVIDER ID
NE
Enumeration date
12/01/2005
Last updated
06/28/2018
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