MEDICARE: GARY LEE KIMBERLIN DMD

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	DS019543L	PA

General Provider Information

NPI Number	:	1467516385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY LEE KIMBERLIN DMD

Provider Business Mailing Address
First Line	:	PO BOX 316
Second Line	:
City	:	WILLIAMSVILLE
State	:	NY
Zip	:	14231
Country	:	US
Telephone Number	:	716-204-4998
Fax Number	:	716-632-7966

Provider Business Practice Location Address
First Line	:	67 BRUMBAUGH AVE
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-2801
Country	:	US
Telephone Number	:	717-263-6060
Fax Number	:	717-263-7190

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

Provider Enumeration Date	:	12/22/2006
Last Update Date	:	01/12/2026

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