Individual
DR. MICHAEL KEITH KIMBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1602 LAKEWOOD DRIVE, ELIZABETHTOWN, KY 42701-5458
(270) 765-6552
(270) 769-3797
Mailing address
1602 LAKEWOOD DRIVE, ELIZABETHTOWN, KY 42701-5458
(270) 765-6552
(270) 769-3797
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4787
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
799542
UNITED CONCORDIA COMP INC
—
Enumeration date
08/23/2006
Last updated
07/08/2007
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