Provider Demographics
NPI:1740700145
Name:KIMMEL, JOSEPH BRANDON (LICENSED DENTURIST)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:BRANDON
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:LICENSED DENTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7327 5TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6706
Mailing Address - Country:US
Mailing Address - Phone:360-704-9070
Mailing Address - Fax:
Practice Address - Street 1:806 YELM AVE E # 7
Practice Address - Street 2:
Practice Address - City:YELM
Practice Address - State:WA
Practice Address - Zip Code:98597-9424
Practice Address - Country:US
Practice Address - Phone:360-704-9070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-27
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN60737872122400000X
122400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122400000XDental ProvidersDenturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADN60737872OtherDENTURIST LICENSE