Provider Demographics
NPI:1790798056
Name:KIMBERLY DENTAL ASSOCIATES LLP
Entity Type:Organization
Organization Name:KIMBERLY DENTAL ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:BEKX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:920-788-1263
Mailing Address - Street 1:PO BOX 100
Mailing Address - Street 2:
Mailing Address - City:KIMBERLY
Mailing Address - State:WI
Mailing Address - Zip Code:54136
Mailing Address - Country:US
Mailing Address - Phone:920-788-1263
Mailing Address - Fax:920-788-0333
Practice Address - Street 1:203 W KIMBERLY AVE
Practice Address - Street 2:
Practice Address - City:KIMBERLY
Practice Address - State:WI
Practice Address - Zip Code:54136
Practice Address - Country:US
Practice Address - Phone:920-788-1263
Practice Address - Fax:920-788-0333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31511223G0001X
WI45411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty