Provider Demographics
NPI:1295100907
Name:KIMBALL AND BEECHER MARSHALLTOWN PLLC
Entity type:Organization
Organization Name:KIMBALL AND BEECHER MARSHALLTOWN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING/INSURANCE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MOLLY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SPENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-235-6287
Mailing Address - Street 1:4015 HURST DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9035
Mailing Address - Country:US
Mailing Address - Phone:319-235-6287
Mailing Address - Fax:
Practice Address - Street 1:101 E SOUTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:MARSHALLTOWN
Practice Address - State:IA
Practice Address - Zip Code:50158-4552
Practice Address - Country:US
Practice Address - Phone:641-753-3383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KIMBALL AND BEECHER FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-12-07
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA87591223G0001X
IA80351223G0001X
IA60671223G0001X
IA59641223G0001X
IA79991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA129460Medicaid
IA137828Medicaid