Healthcare Provider Details

I. General information

NPI: 1134511736
Provider Name (Legal Business Name): CATHERINE DAYNE KIMBLE DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2015
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6116 E ARBOR AVE STE 110
MESA AZ
85206-6103
US

IV. Provider business mailing address

6116 E ARBOR AVE STE 110
MESA AZ
85206-6103
US

V. Phone/Fax

Practice location:
  • Phone: 602-992-1486
  • Fax:
Mailing address:
  • Phone: 602-992-1486
  • Fax: 602-992-6604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberD012780
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD012780
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9664
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code1223X2210X
TaxonomyOrofacial Pain Dentistry
License NumberD012780
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: