Healthcare Provider Details

I. General information

NPI: 1326245796
Provider Name (Legal Business Name): KIMBERLY VICTORIA PINGEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/29/2007
Last Update Date: 08/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BRYANT ST
DUBUQUE IA
52003-7405
US

IV. Provider business mailing address

957 MAIN ST UNIT 301
DUBUQUE IA
52001-6710
US

V. Phone/Fax

Practice location:
  • Phone: 563-557-7001
  • Fax:
Mailing address:
  • Phone: 612-219-4351
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number08897
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number6857-15
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: