Provider Demographics
NPI:1023244159
Name:KIND-BAUER, KIMBERLY A (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:A
Last Name:KIND-BAUER
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 1:4445 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-4642
Mailing Address - Country:US
Mailing Address - Phone:262-554-1600
Mailing Address - Fax:262-554-1640
Practice Address - Street 1:4445 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:RACINE
Practice Address - State:WI
Practice Address - Zip Code:53405-4642
Practice Address - Country:US
Practice Address - Phone:262-554-1600
Practice Address - Fax:262-554-1640
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3755122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist