Healthcare Provider Details

I. General information

NPI: 1104984483
Provider Name (Legal Business Name): CARL MCCAMEY KIMBLER DMD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 03/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 1ST AVE SE SUITE 400
ABERDEEN SD
57401-4601
US

IV. Provider business mailing address

820 1ST AVE SE SUITE 400
ABERDEEN SD
57401-4601
US

V. Phone/Fax

Practice location:
  • Phone: 605-225-9362
  • Fax: 605-229-7317
Mailing address:
  • Phone: 605-225-9362
  • Fax: 605-229-7317

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberM862
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberSD4237
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: