Provider Demographics
NPI:1053311977
Name:KIMBREL, PAUL L (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:L
Last Name:KIMBREL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 1ST ST
Mailing Address - Street 2:
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97034-2328
Mailing Address - Country:US
Mailing Address - Phone:503-636-2525
Mailing Address - Fax:503-697-5999
Practice Address - Street 1:601 1ST ST
Practice Address - Street 2:
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97034-2328
Practice Address - Country:US
Practice Address - Phone:503-636-2525
Practice Address - Fax:503-697-5999
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR54061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice