Active NPI
R. Denton Kimbrough, D.M.D.
- General Practice Dentistry
- Huntsville, AL
National Provider Identifier
1215950670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 3431
- Practice address
- 1101 Gleneagles Dr SW
Huntsville, AL 35801-6405 - Phone
- (256) 881-0024
- Fax
- (256) 881-8982
- NPI assigned
- Jul 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3431 | AL | Primary |
Addresses
Primary practice location
1101 Gleneagles Dr SW
Huntsville, AL 35801-6405
Mailing address
1101 Gleneagles Dr SW
Huntsville, AL 35801-6405
Phone (256) 881-0024
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 92171 | Other | AL | BLUE CROSS BLUE SHIELD |
| 852858 | Other | AL | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Nov 12, 2015 through Nov 12, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3431 | AL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153872000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215950670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1101 GLENEAGLES DR SW",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358016405",
"telephone_number": "256-881-0024",
"fax_number": "256-881-8982"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1101 GLENEAGLES DR SW",
"city": "HUNTSVILLE",
"state": "AL",
"postal_code": "358016405",
"telephone_number": "256-881-0024",
"fax_number": "256-881-8982"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBROUGH",
"first_name": "R.",
"middle_name": "DENTON",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "AL",
"license": "3431",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "92171",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "852858",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Huntsville, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.