Healthcare Provider Details

I. General information

NPI: 1174060883
Provider Name (Legal Business Name): KIMBALL & BEECHER CEDAR RAPIDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2017
Last Update Date: 01/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4015 HURST DR
WATERLOO IA
50701-9035
US

IV. Provider business mailing address

2120 WESTDALE DR SW
CEDAR RAPIDS IA
52404-6318
US

V. Phone/Fax

Practice location:
  • Phone: 319-235-6287
  • Fax: 319-232-3171
Mailing address:
  • Phone: 319-396-5336
  • Fax: 319-396-4576

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: BEAU BEECHER
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 319-235-6287