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General NPI Number Information
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NPI Number | 1023156692
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Entity Type | Organization
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Legal Business Name | GLENN A. KIMBLE D.D.S.
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Dates
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Enumeration Date | 02/03/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2323 MEMORIAL AVE SUITE 22
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City | LYNCHBURG
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State | VA
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Zip | 24501-2661
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Country | US
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Telephone | 434-847-5847
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Fax | 434-847-4452
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Provider Business Mailing Address
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Address Line | 2323 MEMORIAL AVE SUITE 22
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City | LYNCHBURG
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State | VA
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Zip | 24501-2661
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Country | US
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Telephone | 434-847-5847
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Fax | 434-847-4452
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Authorized Official
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Title or Position | PRACTICE OWNER
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Name | DR. GLENN ANTHONY KIMBLE
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Credential | D.D.S.
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Telephone | 434-847-5847
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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