Individual
MRS. KIMBERLY T. LOUGH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DDS, MS
Contact information
Practice address
12 KANAWHA TER, SUITE B, SAINT ALBANS, WV 25177-2750
(304) 722-7221
(304) 722-0420
Mailing address
12 KANAWHA TER, SUITE B, SAINT ALBANS, WV 25177-2750
(304) 722-7221
(304) 722-0420
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
3415
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4004039000
—
WV
Enumeration date
04/07/2006
Last updated
01/15/2013
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