Provider Demographics
NPI:1760597348
Name:SETH A KIMMELMAN DDS PC
Entity Type:Organization
Organization Name:SETH A KIMMELMAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SETH
Authorized Official - Middle Name:A
Authorized Official - Last Name:KIMMELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:719-447-1199
Mailing Address - Street 1:219 W COLORADO AVE
Mailing Address - Street 2:#206
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903
Mailing Address - Country:US
Mailing Address - Phone:719-447-1199
Mailing Address - Fax:719-227-9228
Practice Address - Street 1:219 W COLORADO AVE
Practice Address - Street 2:#206
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903
Practice Address - Country:US
Practice Address - Phone:719-447-1199
Practice Address - Fax:719-227-9228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty