Provider Demographics
NPI:1811558430
Name:KIMBALL, COLLEEN (DDS)
Entity type:Individual
Prefix:DR
First Name:COLLEEN
Middle Name:
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 VILLAGE VISTA DR UNIT 108
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:CO
Mailing Address - Zip Code:80516-2529
Mailing Address - Country:US
Mailing Address - Phone:303-604-0034
Mailing Address - Fax:
Practice Address - Street 1:3140 VILLAGE VISTA DR UNIT 108
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:CO
Practice Address - Zip Code:80516-2529
Practice Address - Country:US
Practice Address - Phone:303-604-0034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2020-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO002040611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice