Individual
SHAWN KIMBALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
641 KEN PRATT BLVD, LONGMONT, CO 80501-6419
(303) 651-2700
Mailing address
641 KEN PRATT BLVD, LONGMONT, CO 80501-6419
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9982
CO
1223G0001X
General Practice Dentistry
DE00011186
WA
Other
Enumeration date
05/21/2008
Last updated
05/30/2010
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