MEDICARE: DR. SAUL STUART KIMMEL 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	1223G0001X	General Practice Dentistry	029104	NY

General Provider Information

NPI Number	:	1568452571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SAUL STUART KIMMEL D.M.D.

Provider Business Mailing Address
First Line	:	562 ALBANY SHAKER RD
Second Line	:
City	:	LOUDONVILLE
State	:	NY
Zip	:	12211-2118
Country	:	US
Telephone Number	:	518-458-1620
Fax Number	:	518-458-2190

Provider Business Practice Location Address
First Line	:	562 ALBANY SHAKER RD
Second Line	:
City	:	LOUDONVILLE
State	:	NY
Zip	:	12211-2118
Country	:	US
Telephone Number	:	518-458-1620
Fax Number	:	518-458-2190

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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