Healthcare Provider Details

I. General information

NPI: 1881481687
Provider Name (Legal Business Name): KIMBALL & BEECHER GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 04/23/2025
Certification Date: 04/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 MAIN ST NE
BONDURANT IA
50035-7722
US

IV. Provider business mailing address

4015 HURST DR
WATERLOO IA
50701-9035
US

V. Phone/Fax

Practice location:
  • Phone: 515-967-4002
  • Fax:
Mailing address:
  • Phone: 319-235-6287
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: SANDY MARIE CROCK
Title or Position: CONTROLLER
Credential:
Phone: 319-277-6921