Healthcare Provider Details

I. General information

NPI: 1609416817
Provider Name (Legal Business Name): KIMBALL & BEECHER IOWA CITY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 WILLIAM ST
IOWA CITY IA
52240-6628
US

IV. Provider business mailing address

4015 HURST DR
WATERLOO IA
50701-9035
US

V. Phone/Fax

Practice location:
  • Phone: 319-337-2114
  • Fax: 319-232-3171
Mailing address:
  • Phone: 319-235-6287
  • Fax: 319-232-3171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TRACY WOOD
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 319-235-6287