Organization
KIMBALL ENDODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LELAND BLANE KIMBALL DDS (PRESIDENT)
(970) 232-3750
Entity
Organization
Contact information
Practice address
1331 E PROSPECT RD UNIT B1, FORT COLLINS, CO 80525-1367
(970) 232-3750
Mailing address
5603 WEEPING WAY, FORT COLLINS, CO 80528-6398
(415) 595-1957
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
202034
CO
Other
Enumeration date
06/05/2017
Last updated
06/05/2017
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