Provider Demographics
NPI:1427578574
Name:KIMMEL, CHRISTOPHER STEWART (DDS)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:STEWART
Last Name:KIMMEL
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 1:978 PATTERSON ST
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-5423
Mailing Address - Country:US
Mailing Address - Phone:210-249-1897
Mailing Address - Fax:
Practice Address - Street 1:23225 KINGSLAND BLVD STE 300
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77494-3705
Practice Address - Country:US
Practice Address - Phone:281-395-0400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2017-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice