Provider Demographics
NPI:1952522617
Name:KIMMEL, CRAIG MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:MATTHEW
Last Name:KIMMEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9655 WOODLANDS DR
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46037-9309
Mailing Address - Country:US
Mailing Address - Phone:317-579-9984
Mailing Address - Fax:317-899-1117
Practice Address - Street 1:7397 NORTH 600 WEST
Practice Address - Street 2:STE 400
Practice Address - City:MCCORDSVILLE
Practice Address - State:IN
Practice Address - Zip Code:46055-7219
Practice Address - Country:US
Practice Address - Phone:317-335-3395
Practice Address - Fax:317-335-3393
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010744A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist