Provider Demographics
NPI:1477638815
Name:JAMES T GIMBEL DDS PC
Entity Type:Organization
Organization Name:JAMES T GIMBEL DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GIMBEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-386-0301
Mailing Address - Street 1:5335 EASTERN AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-2788
Mailing Address - Country:US
Mailing Address - Phone:563-386-0301
Mailing Address - Fax:563-386-0987
Practice Address - Street 1:5335 EASTERN AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-2788
Practice Address - Country:US
Practice Address - Phone:563-386-0301
Practice Address - Fax:563-386-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2011-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA068351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
107305OtherUNITED CONCORDIA
IA0009977Medicaid
19764OtherWELLMARK FEDERAL