Kimberly A. Dettori, D.D.S., M.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

DN12143 Issued in FL

Practice address

903 SE Ocean Blvd
Suite 1
Stuart, FL 34994-2475

Phone

(772) 221-3700

Fax

(772) 221-9107

NPI assigned

Jul 1, 2006

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 FL

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

Credentials

Master of Science

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kimberly a. Dettori, D.D.S., M.S., P.a.

  • Endodontics
  • Stuart, FL
  • NPI 1821024522
  NPD (past) Authorized official

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

{
    "created_epoch": "1151712000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1457049600000",
    "number": "1730118829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "903 SE OCEAN BLVD",
            "address_2": "SUITE 1",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349942475",
            "telephone_number": "772-221-3700",
            "fax_number": "772-221-9107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "903 SE OCEAN BLVD",
            "address_2": "SUITE 1",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349942475",
            "telephone_number": "772-221-3700",
            "fax_number": "772-221-9107"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DETTORI",
        "first_name": "KIMBERLY",
        "middle_name": "A.",
        "credential": "D.D.S., M.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-01",
        "last_updated": "2016-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "FL",
            "license": "DN12143",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Stacie M Desjardins, MOTR/L
• Elaine Desman, CRNA
• Scott M Desman, M.D.
• Melisssa Desposito, MSW
• Chelsea Detter
• Zachary Deutch, MD/MBA
• Stephanie Diane Devaney, ARNP
• Irena Devarie Gonzalez
• Alexandra Grace Devault
• Walter D Devault III, M.D.

• Endodontics in Stuart, FL
• Providers in Stuart, FL by specialty
• Endodontics in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2016; 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.