Provider Demographics
NPI:1952497620
Name:KIMBROUGH, STEVEN DALE (DMD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:DALE
Last Name:KIMBROUGH
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 SE 14TH ST
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-6810
Mailing Address - Country:US
Mailing Address - Phone:479-271-2299
Mailing Address - Fax:
Practice Address - Street 1:1510 SE 14TH ST
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-6810
Practice Address - Country:US
Practice Address - Phone:479-271-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2953122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist