Provider Demographics
NPI:1801169073
Name:KIMBALL F MOREJON DMD PC
Entity type:Organization
Organization Name:KIMBALL F MOREJON DMD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBALL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOREJON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:480-661-6633
Mailing Address - Street 1:10135 E VIA LINDA
Mailing Address - Street 2:SUITE C-119
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5328
Mailing Address - Country:US
Mailing Address - Phone:480-661-6633
Mailing Address - Fax:480-661-9866
Practice Address - Street 1:10135 E VIA LINDA
Practice Address - Street 2:SUITE C-119
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-5328
Practice Address - Country:US
Practice Address - Phone:480-661-6633
Practice Address - Fax:480-661-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD008134122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty