Provider Demographics
NPI:1023156692
Name:GLENN A. KIMBLE D.D.S.
Entity type:Organization
Organization Name:GLENN A. KIMBLE D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KIMBLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-847-5847
Mailing Address - Street 1:2323 MEMORIAL AVE
Mailing Address - Street 2:SUITE 22
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-2661
Mailing Address - Country:US
Mailing Address - Phone:434-847-5847
Mailing Address - Fax:434-847-4452
Practice Address - Street 1:2323 MEMORIAL AVE
Practice Address - Street 2:SUITE 22
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-2661
Practice Address - Country:US
Practice Address - Phone:434-847-5847
Practice Address - Fax:434-847-4452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty