MEDICARE: DR. KIRSTEN KIMBLER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	7239	NE

General Provider Information

NPI Number	:	1568845865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRSTEN KIMBLER DMD

Provider Business Mailing Address
First Line	:	2223 DODGE ST
Second Line	:	APT 617
City	:	OMAHA
State	:	NE
Zip	:	68102-1912
Country	:	US
Telephone Number	:	605-380-9238
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 S 42ND ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-1002
Country	:	US
Telephone Number	:	605-380-9238
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2015
Last Update Date	:	07/04/2015

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Directions to “ DR. KIRSTEN KIMBLER DMD” Practice Location

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