Provider Demographics
NPI:1902510811
Name:KIMBALL, COURTNEY MARIE (RDH, IPDH)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:MARIE
Last Name:KIMBALL
Suffix:
Gender:F
Credentials:RDH, IPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:HOWLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04448-0456
Mailing Address - Country:US
Mailing Address - Phone:207-290-7797
Mailing Address - Fax:
Practice Address - Street 1:9 MAIN ST
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457-1253
Practice Address - Country:US
Practice Address - Phone:207-794-6700
Practice Address - Fax:207-794-6777
Is Sole Proprietor?:No
Enumeration Date:2023-01-06
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERDH4311124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist