Provider Demographics
NPI:1043267925
Name:KINCAID, MCCLARY & KIM D.D.S, P.S.
Entity Type:Organization
Organization Name:KINCAID, MCCLARY & KIM D.D.S, P.S.
Other - Org Name:KINCAID, MCCLARY & ZYSSET D.D.D. P.S.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PLYMALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-651-1359
Mailing Address - Street 1:16410 SMOKEY POINT BLVD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8415
Mailing Address - Country:US
Mailing Address - Phone:360-658-8822
Mailing Address - Fax:360-659-1275
Practice Address - Street 1:16410 SMOKEY POINT BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8415
Practice Address - Country:US
Practice Address - Phone:360-658-8822
Practice Address - Fax:360-659-1275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000037021223S0112X
WAGA100000271223S0112X
WADE000055241223S0112X
WAGA100000311223S0112X
WADE00086561223S0112X
WAGA100002821223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5337704Medicaid