Active NPI
Eric Lee Kimball, D.D.S.
- General Practice Dentistry
- Waterloo, IA
National Provider Identifier
1639180920
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 7999
- Practice address
- 315 E San Marnan Dr
Waterloo, IA 50702-5837 - Phone
- (319) 235-6287
- Fax
- (319) 235-6740
- NPI assigned
- Aug 11, 2006
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 | 7999 | IA | Primary |
Addresses
Primary practice location
315 E San Marnan Dr
Waterloo, IA 50702-5837
Mailing address
301 Sheridan Rd
Waterloo, IA 50701-4023
Phone (319) 232-8386
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7999IA 002 | Other | IA | DELTA DENTAL OF IOWA |
| 41948 | Other | WELLMARK BCBS PROVIDER # | |
| 640-03389 | Other | AL | BCBS OF ALABAMA |
| 742541 | Other | UNITED CONCORDIA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160112000646 | IA | Order and Referring Only - Dentist | 3870895584 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7999 | IA | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155254400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1639180920",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 SHERIDAN RD",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507014023",
"telephone_number": "319-232-8386"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "315 E SAN MARNAN DR",
"city": "WATERLOO",
"state": "IA",
"postal_code": "507025837",
"telephone_number": "319-235-6287",
"fax_number": "319-235-6740"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMBALL",
"first_name": "ERIC",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-11",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IA",
"license": "7999",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL OF IOWA",
"identifier": "7999IA 002",
"state": "IA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WELLMARK BCBS PROVIDER #",
"identifier": "41948",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF ALABAMA",
"identifier": "640-03389",
"state": "AL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED CONCORDIA",
"identifier": "742541",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Waterloo, IA
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; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.