Theodore S Kimball III, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

AZ4670 Issued in AZ

Practice address

2065 Airway Ave
Suite B
Kingman, AZ 86409-3656

Phone

(928) 718-0002

Fax

(928) 718-0007

NPI assigned

Aug 14, 2007

Last updated

Aug 6, 2015By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Absolute Sleep Treatment Center

  • Sleep Disorder Diagnostic Clinic/Center
  • Kingman, AZ
  • NPI 1760935332
  NPD (past) Authorized official

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

{
    "created_epoch": "1187049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1438819200000",
    "number": "1669664553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2065 AIRWAY AVE",
            "address_2": "SUITE B",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093656",
            "telephone_number": "928-718-0002",
            "fax_number": "928-718-0007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2065 AIRWAY AVE",
            "address_2": "SUITE B",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864093656",
            "telephone_number": "928-718-0002",
            "fax_number": "928-718-0007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIMBALL",
        "first_name": "THEODORE",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "name_suffix": "III",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-08-14",
        "last_updated": "2015-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AZ",
            "license": "AZ4670",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ahmad Saeed Khan, M.D.
• Mahmood Khan, M.D.
• Muhammad Azam Khan, MD
• Kids Little Smiles Dentistry
• Yong Chan Kim, M.D.
• Lewis Miller King III, BA
• Kingman Academy of Learning
• Kingman Behavioral Health LLC (Hickory Behavioral Center at Kingman)
• Kingman Cancer Center
• Kingman Chiropractic Clinic PC (Dennis D and Ryan D Gustafson DC)

• Dentist in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Dentist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2015; 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.

Verify at the official NPI Registry.