Individual
KIMBERLY DIANE BACON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8381 LA PALMA AVE, SUITE B & C, BUENA PARK, CA 90620-3271
(714) 228-9990
(714) 228-9741
Mailing address
8381 LA PALMA AVE, SUITE B & C, BUENA PARK, CA 90620-3271
(714) 228-9990
(714) 228-9741
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
54253991003342
CA
Other
Enumeration date
01/19/2009
Last updated
01/19/2009
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