Provider Demographics
NPI:1053690966
Name:BIGGS-LEWIS, KIMBERLY DANIELLE (DDS)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:DANIELLE
Last Name:BIGGS-LEWIS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2800 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:TX
Mailing Address - Zip Code:75670-0565
Mailing Address - Country:US
Mailing Address - Phone:903-742-9451
Mailing Address - Fax:936-564-3907
Practice Address - Street 1:1023 N MOUND ST STE D
Practice Address - Street 2:
Practice Address - City:NACOGDOCHES
Practice Address - State:TX
Practice Address - Zip Code:75961-4453
Practice Address - Country:US
Practice Address - Phone:936-554-6397
Practice Address - Fax:936-564-3907
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice