Provider Demographics
NPI:1073609285
Name:MOREJON, KIMBALL (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIMBALL
Middle Name:
Last Name:MOREJON
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 1:10135 E VIA LINDA
Mailing Address - Street 2:C-119
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5328
Mailing Address - Country:US
Mailing Address - Phone:480-661-6633
Mailing Address - Fax:
Practice Address - Street 1:10135 E VIA LINDA
Practice Address - Street 2:C-119
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5328
Practice Address - Country:US
Practice Address - Phone:480-661-6633
Practice Address - Fax:480-661-9866
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist