Provider Demographics
NPI:1346377470
Name:LOE, KIMBAL WAYNE (DDS)
Entity Type:Individual
Prefix:
First Name:KIMBAL
Middle Name:WAYNE
Last Name:LOE
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 1:3100 S PARKER RD
Mailing Address - Street 2:#103
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6217
Mailing Address - Country:US
Mailing Address - Phone:303-337-2794
Mailing Address - Fax:303-337-2848
Practice Address - Street 1:3100 S PARKER RD
Practice Address - Street 2:#103
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6217
Practice Address - Country:US
Practice Address - Phone:303-337-2794
Practice Address - Fax:303-337-2848
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1049931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice