Provider Demographics
NPI:1487184313
Name:RAABE, KIMBERLY ELLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:ELLEN
Last Name:RAABE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:RAABE
Other - Last Name:MCBARNET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2210 N FRAZIER ST STE 120
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77303-1701
Mailing Address - Country:US
Mailing Address - Phone:936-539-3636
Mailing Address - Fax:
Practice Address - Street 1:2210 N FRAZIER ST STE 120
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77303-1701
Practice Address - Country:US
Practice Address - Phone:936-539-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX329941223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice