Provider Demographics
NPI:1598918187
Name:GIMBEL, JAMES THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:THOMAS
Last Name:GIMBEL
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 1:5335 EASTERN AVE
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 AVE
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
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA68351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice