Provider Demographics
NPI:1346268612
Name:KIMBALL, DON H (DDS)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:H
Last Name:KIMBALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3232 IMPERIAL ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3366
Mailing Address - Country:US
Mailing Address - Phone:801-485-0373
Mailing Address - Fax:
Practice Address - Street 1:2860 W 4700 S
Practice Address - Street 2:SUITE A
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84118-2157
Practice Address - Country:US
Practice Address - Phone:801-968-1142
Practice Address - Fax:801-968-0408
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1368901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice