NPIMap

Organization Active NPI

Kimberly Park Dental Associates

  • Dentist
  • Davenport, IA
National Provider Identifier
1689762494
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
KIMBERLY PARK DENTAL ASSOCIATES
Practice address
3512 Jersey Ridge Rd
Davenport, IA 52807-3332
Phone
(563) 359-3494
NPI assigned
Oct 10, 2006
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Thomas William Thul, DDSNPI 1538221049
Title
President Dentist
Phone
(563) 359-3494

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X NU Primary

Addresses

Primary practice location

3512 Jersey Ridge Rd
Davenport, IA 52807-3332

Mailing address

3512 Jersey Ridge Rd
Davenport, IA 52807-3332

Other identifiers 5

IdentifierTypeStateIssuer
0096222OtherIAJOHNSON
0099382OtherIASLIVKEN
709842OtherIABLUE CROSS T
755644OtherIABLUE CROSS J
710728OtherIABLUE CROSS S

Other names 1

  • Marc C Slivken David A Johnson Thomas A Thol Other name

National Provider Directory

National Provider Directory

Locations

3512 Jersey Ridge Rd
Davenport, IA 52807
Phone (563) 359-3494

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1160438400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1689762494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3512 JERSEY RIDGE RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073332"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3512 JERSEY RIDGE RD",
            "city": "DAVENPORT",
            "state": "IA",
            "postal_code": "528073332",
            "telephone_number": "563-359-3494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIMBERLY PARK DENTAL ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-10",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "THUL",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "WILLIAM",
        "authorized_official_title_or_position": "PRESIDENT DENTIST",
        "authorized_official_telephone_number": "563-359-3494",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHNSON",
            "identifier": "0096222",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SLIVKEN",
            "identifier": "0099382",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS T",
            "identifier": "709842",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS J",
            "identifier": "755644",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS S",
            "identifier": "710728",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Marc C Slivken David A Johnson Thomas A Thol",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Davenport, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.