Active NPI
Kimberley Brooke Mowery, DMD
- General Practice Dentistry
- Gainesville, FL
National Provider Identifier
1063716678
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- DN15902
- Practice address
- 4960 Newberry Road
Suite 220
Gainesville, FL 32607 - Phone
- (352) 332-6725
- Fax
- (352) 332-6725
- NPI assigned
- Dec 23, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | DN15902 | FL | Primary |
Addresses
Primary practice location
4960 Newberry Road
Suite 220
Gainesville, FL 32607
Mailing address
4960 Newberry Road
Suite 220
Gainesville, FL 32607
Phone (352) 332-6725
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 18, 2024 through Feb 18, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN15902 | FL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1293062400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1293062400000",
"number": "1063716678",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4960 NEWBERRY ROAD",
"address_2": "SUITE 220",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "32607",
"telephone_number": "352-332-6725",
"fax_number": "352-372-1717"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4960 NEWBERRY ROAD",
"address_2": "SUITE 220",
"city": "GAINESVILLE",
"state": "FL",
"postal_code": "32607",
"telephone_number": "352-332-6725",
"fax_number": "352-332-6725"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOWERY",
"first_name": "KIMBERLEY",
"middle_name": "BROOKE",
"name_prefix": "Mrs.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-12-23",
"last_updated": "2010-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "FL",
"license": "DN15902",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gainesville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.