MEDICARE: DR. MICHAEL B KIMBLE D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2007004132	MO

General Provider Information

NPI Number	:	1437208477
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL B KIMBLE D.M.D.

Provider Business Mailing Address
First Line	:	356 BROOKHAVEN DR
Second Line	:
City	:	O FALLON
State	:	MO
Zip	:	63368-9630
Country	:	US
Telephone Number	:	636-485-5351
Fax Number	:

Provider Business Practice Location Address
First Line	:	3865 MEXICO RD
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3042
Country	:	US
Telephone Number	:	636-447-4630
Fax Number	:	636-447-4726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	02/03/2023

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