Kimberly Gail Packer, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10689 Issued in MD

Practice address

1500 Blenhiem LN
Suite D
Havre de Grace, MD 21078-2040

Phone

(410) 939-6003

Fax

(410) 939-5003

NPI assigned

May 18, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1179446400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1224547200000",
    "number": "1043428667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1500 BLENHIEM LN",
            "address_2": "SUITE D",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210782040",
            "telephone_number": "410-939-6003",
            "fax_number": "410-939-5003"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 BLENHIEM LN",
            "address_2": "SUITE D",
            "city": "HAVRE DE GRACE",
            "state": "MD",
            "postal_code": "210782040",
            "telephone_number": "410-939-6003",
            "fax_number": "410-939-5003"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PACKER",
        "first_name": "KIMBERLY",
        "middle_name": "GAIL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-05-18",
        "last_updated": "2008-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MD",
            "license": "10689",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vincent M Osteria, MD
• Theresa Otwell
• Amber Owens, LGSW
• P.S. Psychological Services
• Sandra Theresa Pabst, RN
• Kimberley Jayne Parks Bourn, LCSWC
• Lori Anne Passerini, LCSW-C
• Shaivi Asit Patel, MD
• Edward J Patro, OD
• Paul D. Chizmar DDS PA

• General Practice Dentistry in Havre de Grace, MD
• Providers in Havre de Grace, MD by specialty
• General Practice Dentistry in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.