KIMBERLY PARK DENTAL ASSOCIATES (NPI# 1689762494) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689762494 |
| Entity Type | Organization |
| Organization Name | KIMBERLY PARK DENTAL ASSOCIATES |
| Other Organization Name | MARC C SLIVKEN DAVID A JOHNSON THOMAS A THOL |
| Practice Address |
3512 Jersey Ridge Rd Davenport IA 52807-3332 |
| Practice Telephone | 5633593494 |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. THOMAS WILLIAM THUL (PRESIDENT DENTIST) |
| Authorized Official Telephone | 5633593494 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IA | BLUE CROSS J | 755644 | 01 |
| IA | SLIVKEN | 0099382 | 01 |
| IA | JOHNSON | 0096222 | 01 |
| IA | BLUE CROSS T | 709842 | 01 |
| IA | BLUE CROSS S | 710728 | 01 |
| Other Name | Type Code |
|---|---|
| Marc C Slivken David A Johnson Thomas A Thol | Other Name - Individual/Organization |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Iowa Business Entities | KIMBERLY PARK DENTAL ASSOCIATES, P.C. | 3512 Jersey Ridge Rd, Davenport, IA 52807 |
| Street Address |
3512 JERSEY RIDGE RD |
| City | DAVENPORT |
| State | IA |
| Zip Code | 52807-3332 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124180534 | Marc Charles Slivken | Dentist | 3512 Jersey Ridge Rd, Davenport, IA 52807-2223 | 2006-12-14 |
| 1538221049 | Thomas William Thul | Dentist | 3512 Jersey Ridge Rd, Davenport, IA 52807-2223 | 2006-12-14 |
| 1669534087 | David Alan Johnson | Dentist | 3512 Jersey Ridge Rd, Davenport, IA 52807-2223 | 2006-12-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710455423 | Sarah Duvall | Pharmacist | 2790 East 53rd Street, Davenport, IA 52807 | 2018-11-12 |
| 1932686375 | Costco Wholesale Corporation | Hearing Aid Equipment | 2790 East 53rd St., Davenport, IA 52807 | 2018-07-27 |
| 1902258379 | Secure Dental II, LLC | Dentist | 5025 Utica Ridge Rd, Suite 103, Davenport, IA 52807 | 2016-07-08 |
| 1003288663 | Kristin Landram | Pharmacist | 4011 E 53rd Street, Davenport, IA 52807 | 2015-10-22 |
| 1912384918 | Toshia Johnson | Counselor | 3515 Spring Street, Davenport, IA 52807 | 2015-04-29 |
| 1366849440 | Dennis Aaron Brown | Counselor | 2322 E. Kimberly Rd., Ste. 200 N., Davenport, IA 52807 | 2014-12-04 |
| 1033514914 | Rachel J Staron | Counselor | 2028 E 38th St Ste 3-5, Davenport, IA 52807 | 2014-11-04 |
| 1447651518 | Anthony B. Dexter | Chiropractor | 2178 E Kimberly Rd Ste 400, Davenport, IA 52807 | 2014-09-09 |
| 1932517588 | Alan Christopher Rubach | Dentist | 3435 Spring St Ste 2, Davenport, IA 52807 | 2014-07-28 |
| 1851707459 | Allison Maxwell | Behavioral Analyst | 4959 Utica Ridge Rd, Davenport, IA 52807 | 2014-07-03 |
| Find all providers in zip 52807 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568005999 | Davenport Modern Dentistry, Pa | Dentist | 1159 Posner Blvd, Davenport, FL 33837-3664 | 2019-10-17 |
| 1740756139 | Dague Dental Solutions | Dentist | 4711 N Brady St Ste 5s, Davenport, IA 52806-3955 | 2018-10-23 |
| 1871086405 | Mateo Vidales | Dentist | 7700 Lake Wilson Rd, Davenport, FL 33896-9601 | 2018-06-08 |
| 1083105878 | Kunmin Roo | Dentist | 5025 Utica Ridge Rd Ste 103, Davenport, IA 52807-3035 | 2018-05-29 |
| 1902258379 | Secure Dental II, LLC | Dentist | 5025 Utica Ridge Rd, Suite 103, Davenport, IA 52807 | 2016-07-08 |
| 1891176160 | Annissa Michael | Dentist | 7551 Osceola Polk Line Road, Davenport, FL 33896 | 2015-06-12 |
| 1932517588 | Alan Christopher Rubach | Dentist | 3435 Spring St Ste 2, Davenport, IA 52807 | 2014-07-28 |
| 1821285776 | Brian Arthur Mykleby | Dentist | 2215 E 52nd St Ste 1, Davenport, IA 52807-2786 | 2007-09-25 |
| 1356561047 | Valerie Jennings | Dentist | 4624 Progress Drive, Suite E, Davenport, IA 52807-3490 | 2007-04-26 |
| 1245373737 | Monica Foley | Dentist | 1850 E 53rd St Ste 5, Davenport, IA 52807-2784 | 2007-02-14 |
| Find all providers in DAVENPORT | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.