Provider Demographics
NPI:1306951991
Name:KIMBALL, STANLEY C III (DDS)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:C
Last Name:KIMBALL
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23961 CALLE MAGDALENA # 102
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-586-6030
Mailing Address - Fax:949-586-7300
Practice Address - Street 1:23961 CALLE MAGDALENA # 102
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-586-6030
Practice Address - Fax:949-586-7300
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist