1952522617 NPI number — DR. CRAIG MATTHEW KIMMEL D.D.S.

Table of content: DR. CRAIG MATTHEW KIMMEL D.D.S. (NPI 1952522617)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952522617 NPI number — DR. CRAIG MATTHEW KIMMEL D.D.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KIMMEL
Provider First Name:
CRAIG
Provider Middle Name:
MATTHEW
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.D.S.
Provider Gender Code:
M

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:
1952522617
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9655 WOODLANDS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FISHERS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46037-9309
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-579-9984
Provider Business Mailing Address Fax Number:
317-899-1117

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7397 NORTH 600 WEST
Provider Second Line Business Practice Location Address:
STE 400
Provider Business Practice Location Address City Name:
MCCORDSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46055-7219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-335-3395
Provider Business Practice Location Address Fax Number:
317-335-3393
Provider Enumeration Date:
05/01/2007

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:  12010744A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com