Provider Demographics
NPI:1104984483
Name:KIMBLER, CARL MCCAMEY (DMD MD)
Entity type:Individual
Prefix:
First Name:CARL
Middle Name:MCCAMEY
Last Name:KIMBLER
Suffix:
Gender:M
Credentials:DMD MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 1ST AVE SE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57401-4601
Mailing Address - Country:US
Mailing Address - Phone:605-225-9362
Mailing Address - Fax:605-229-7317
Practice Address - Street 1:820 1ST AVE SE
Practice Address - Street 2:SUITE 400
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-4601
Practice Address - Country:US
Practice Address - Phone:605-225-9362
Practice Address - Fax:605-229-7317
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8621223S0112X
SDSD42371223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND41240Medicaid
SD0006084OtherBLUE CROSS
SD8000400Medicaid
SD8000400Medicaid
SD0006084OtherBLUE CROSS