Provider Demographics
NPI:1487831871
Name:KIMBALL, PETER T (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:T
Last Name:KIMBALL
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Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:30131 TOWN CENTER DR
Mailing Address - Street 2:SUITE 196
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-2034
Mailing Address - Country:US
Mailing Address - Phone:949-363-3350
Mailing Address - Fax:949-363-3351
Practice Address - Street 1:30190 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677
Practice Address - Country:US
Practice Address - Phone:949-363-3350
Practice Address - Fax:949-363-3351
Is Sole Proprietor?:No
Enumeration Date:2008-01-28
Last Update Date:2014-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA400841223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics