Provider Demographics
NPI:1831263862
Name:ELLIOT H KIMMEL & ASSOCIATES PC
Entity type:Organization
Organization Name:ELLIOT H KIMMEL & ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIOT
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:KIMMEL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:860-447-1714
Mailing Address - Street 1:27 BROAD STREET
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-5973
Mailing Address - Country:US
Mailing Address - Phone:860-447-1714
Mailing Address - Fax:860-447-0363
Practice Address - Street 1:27 BROAD STREET
Practice Address - Street 2:
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-5973
Practice Address - Country:US
Practice Address - Phone:860-447-1714
Practice Address - Fax:860-447-0363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty