Provider Demographics
NPI:1164631057
Name:CREATIVE DENTAL TED H. KIMBALL
Entity Type:Organization
Organization Name:CREATIVE DENTAL TED H. KIMBALL
Other - Org Name:CREATIVE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR DDS
Authorized Official - Prefix:
Authorized Official - First Name:TED
Authorized Official - Middle Name:H
Authorized Official - Last Name:KIMBALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:530-751-1977
Mailing Address - Street 1:1262 COLUSA AVE
Mailing Address - Street 2:
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3653
Mailing Address - Country:US
Mailing Address - Phone:530-751-1977
Mailing Address - Fax:530-751-1997
Practice Address - Street 1:1262 COLUSA AVE
Practice Address - Street 2:
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3653
Practice Address - Country:US
Practice Address - Phone:530-751-1977
Practice Address - Fax:530-751-1997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty