Provider Demographics
NPI:1972625655
Name:KIMBREL, RICK L I (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICK
Middle Name:L
Last Name:KIMBREL
Suffix:I
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 1:1209 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:VIDALIA
Mailing Address - State:GA
Mailing Address - Zip Code:30474-5500
Mailing Address - Country:US
Mailing Address - Phone:912-537-7048
Mailing Address - Fax:
Practice Address - Street 1:1209 E 1ST ST
Practice Address - Street 2:
Practice Address - City:VIDALIA
Practice Address - State:GA
Practice Address - Zip Code:30474-5500
Practice Address - Country:US
Practice Address - Phone:912-537-7048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0109021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice