Provider Demographics
NPI:1366156820
Name:KIMBALL & BEECHER GROUP LLC
Entity type:Organization
Organization Name:KIMBALL & BEECHER GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:CROCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-277-6921
Mailing Address - Street 1:4015 HURST DR
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50701-9035
Mailing Address - Country:US
Mailing Address - Phone:319-235-6287
Mailing Address - Fax:319-232-3171
Practice Address - Street 1:3520 UTICA RIDGE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-1620
Practice Address - Country:US
Practice Address - Phone:563-359-9165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-10
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty