1063420099 NPI number — DR. JOAN HARWOOD KIMBALL DMD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063420099 NPI number — DR. JOAN HARWOOD KIMBALL DMD

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARWOOD KIMBALL
Provider Other First Name:
JOAN
Provider Other Middle Name:
ALICE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DMD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1063420099
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
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
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:
PLAINSTOW
Provider Business Practice Location Address State Name:
NH
Provider Business Practice Location Address Postal Code:
03865
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:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

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: "Y" .
  • Taxonomy code: 122300000X , with the licence number: 15342 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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