Provider Demographics
NPI:1932328135
Name:KIMMELMAN, SETH ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:ANDREW
Last Name:KIMMELMAN
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 1:219 W COLORADO AVE
Mailing Address - Street 2:ST 206
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-3336
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:ST 206
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-3336
Practice Address - Country:US
Practice Address - Phone:719-447-1199
Practice Address - Fax:719-227-9228
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO72211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice