1700026713 NPI number — JOAN H. KIMBALL, DMD

Table of content: (NPI 1700026713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700026713 NPI number — JOAN H. KIMBALL, DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOAN H. KIMBALL, DMD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700026713
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 WENTWORTH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAISTOW
Provider Business Mailing Address State Name:
NH
Provider Business Mailing Address Postal Code:
03865-3136
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
603-382-5138
Provider Business Mailing Address Fax Number:
603-382-6071

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 WENTWORTH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAISTOW
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03865-3136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-382-5138
Provider Business Practice Location Address Fax Number:
603-382-6071
Provider Enumeration Date:
03/03/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KIMBALL
Authorized Official First Name:
JOAN
Authorized Official Middle Name:
HARWOOD
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
603-382-5138

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2238 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223G0001X , with the licence number: 2238 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 30004940 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".