Provider Demographics
NPI:1568845865
Name:KIMBLER, KIRSTEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KIRSTEN
Middle Name:
Last Name:KIMBLER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2223 DODGE ST
Mailing Address - Street 2:APT 617
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68102-1912
Mailing Address - Country:US
Mailing Address - Phone:605-380-9238
Mailing Address - Fax:
Practice Address - Street 1:600 S 42ND ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68198-1002
Practice Address - Country:US
Practice Address - Phone:605-380-9238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-04
Last Update Date:2015-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE72391223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery