Individual
DR. LELAND BLANE KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1724 NEBRASKA AVE, USA DENTAC, FORT LEONARD WOOD, MO 65473
(573) 596-0388
(573) 596-0410
Mailing address
1724 NEBRASKA AVE, USA DENTAC, FORT LEONARD WOOD, MO 65473
(573) 596-0388
(573) 596-0410
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
55011
CA
1223G0001X
General Practice Dentistry
55011
CA
Other
Enumeration date
10/20/2006
Last updated
06/29/2010
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