Provider Demographics
NPI:1639788078
Name:KIMBLE, MIRANDA JORDAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:JORDAN
Last Name:KIMBLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 WETHERSFIELD XING
Mailing Address - Street 2:
Mailing Address - City:HURRICANE
Mailing Address - State:WV
Mailing Address - Zip Code:25526-8716
Mailing Address - Country:US
Mailing Address - Phone:304-545-8133
Mailing Address - Fax:
Practice Address - Street 1:422 KINETIC DR STE A
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25701-5268
Practice Address - Country:US
Practice Address - Phone:304-525-0016
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV4470122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist