John Norman Kimmich, DDS
Individual provider Active NPI Dentist · Dupo, IL
NPI 1972773281 · NPPES record last updated Oct 30, 2012
Key facts
- NPI
- 1972773281
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 013590 (MO)
- Practice address
- 195 S Main St
Dupo, IL 62239-1347 - Phone
- (618) 286-4400
- Fax
- (618) 286-4407
- NPI assigned
- Mar 4, 2008
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 013590 | MO | Yes |
Addresses
Primary practice location
195 S Main St
Dupo, IL 62239-1347
Mailing address
195 S Main St
Dupo, IL 62239-1347
Phone (618) 286-4400
Other providers in Dupo, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 30, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.