Provider Demographics
NPI:1003908575
Name:KINTZ, ROBERT L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:L
Last Name:KINTZ
Suffix:
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 1:6025 3 MILE RD NE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9591
Mailing Address - Country:US
Mailing Address - Phone:616-682-1708
Mailing Address - Fax:
Practice Address - Street 1:2144 E PARIS AVE SE
Practice Address - Street 2:SUITE 150
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546-6111
Practice Address - Country:US
Practice Address - Phone:616-942-2000
Practice Address - Fax:616-942-6805
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIRK0153321223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU44774Medicare UPIN
MID16069005Medicare PIN