Thomas R Kimball, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901012285 Issued in MI

Practice address

515 Lakeside Dr
Suite 105
Grand Rapids, MI 49506

Phone

(616) 458-2011

Fax

(616) 458-9719

NPI assigned

Nov 6, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162771200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497824395",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "515 LAKESIDE DR",
            "address_2": "SUITE 105",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49506",
            "telephone_number": "616-458-2011",
            "fax_number": "616-458-9719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "515 LAKESIDE DR",
            "address_2": "SUITE 105",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "49506",
            "telephone_number": "616-458-2011",
            "fax_number": "616-458-9719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "THOMAS",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901012285",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Maria Kim, DO
• Roderick Kim, M.D.
• Sean Seungwon Won Kim, DO
• Andrew Scott Kimball, M.D.
• Cynthia Louise Kimball, LMSW, ACSW, ACHP-SW
• Kimber Decker Counseling and Consultation PLLC
• Kimberly Lichon-Tufer
• Elaina Marie Kimbrell, LMSW
• Angelia Kimbrough
• Jamiyah Monye Kimbrough

• Dentist in Grand Rapids, MI
• Providers in Grand Rapids, MI by specialty
• Dentist in Michigan

• 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.