| Kimberly T. Lough, Dds, Ms, Pllc | |
|
12 Kanawha Ter Suite B St Albans WV 25177 | |
| (304) 722-7221 | |
| (304) 722-0420 |
| Full Name | Kimberly T. Lough, Dds, Ms, Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 12 Kanawha Ter, St Albans, West Virginia |
| Authorized Official Name and Position | Kimberly T Lough (PEDIATRIC DENTIST / OWNER) |
| Authorized Official Contact | 3047227221 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Kimberly T. Lough, Dds, Ms, Pllc 12 Kanawha Terrace Suite B St Albans WV 25177 Ph: (304) 722-7221 | Kimberly T. Lough, Dds, Ms, Pllc 12 Kanawha Ter Suite B St Albans WV 25177 Ph: (304) 722-7221 |
| NPI Number | 1992905129 |
|---|---|
| Provider Enumeration Date | 07/25/2007 |
| Last Update Date | 06/13/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992905129 | NPI | - | NPPES |
| 4004039000 | Medicaid | WV |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 3415 (West Virginia) | Primary |
| 1223P0221X | Dentist - Pediatric Dentistry | 3783 (West Virginia) | Secondary |