Organization
NORTHERN PLAINS ORAL AND MAXILLOFACIAL SURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CARL M KIMBLER DMD MD (OWNER)
(605) 225-9362
Entity
Organization
Contact information
Practice address
820 1ST AVE SE, SUITE 400, ABERDEEN, SD 57401-4601
(605) 225-9362
(605) 229-7317
Mailing address
820 1ST AVE SE, SUITE 400, ABERDEEN, SD 57401-4601
(605) 225-9362
(605) 229-7317
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
M862
SD
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
SD4237
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006084
BLUE CROSS
SD
05
—
41240
—
ND
05
—
8000400
—
SD
Enumeration date
12/21/2006
Last updated
03/25/2013
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