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General NPI Number Information
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NPI Number | 1235451949
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Entity Type | Organization
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Legal Business Name | KIMBALL DENTAL CORPORATION
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Dates
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Enumeration Date | 02/22/2010
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Last Update Date | 02/22/2010
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Provider Practice Location Address
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Address Line | 522 N MAGNOLIA AVE
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City | ANAHEIM
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State | CA
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Zip | 92801-4937
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Country | US
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Telephone | 714-828-1415
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Fax |
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Provider Business Mailing Address
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Address Line | 522 N MAGNOLIA AVE
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City | ANAHEIM
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State | CA
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Zip | 92801-4937
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/C.E.O.
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Name | CHARLES KIMBALL
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Credential | D.D.S.
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Telephone | 310-619-1100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47494
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License Number State | CA
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