Provider Demographics
NPI:1417071408
Name:KIMBALL, JAMES FOSTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:FOSTER
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 1:102 WALNUT ST STE G
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403-1118
Mailing Address - Country:US
Mailing Address - Phone:423-266-7927
Mailing Address - Fax:423-265-3103
Practice Address - Street 1:102 WALNUT ST STE G
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37403-1118
Practice Address - Country:US
Practice Address - Phone:423-266-7927
Practice Address - Fax:423-265-3103
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS000032281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice