Provider Demographics
NPI:1073862637
Name:KINGFIELD FAMILY DENTAL & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:KINGFIELD FAMILY DENTAL & ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FREEMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYNEWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-353-5443
Mailing Address - Street 1:17 E 38TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1341
Mailing Address - Country:US
Mailing Address - Phone:612-353-5443
Mailing Address - Fax:
Practice Address - Street 1:17 E 38TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1341
Practice Address - Country:US
Practice Address - Phone:612-353-5443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-29
Last Update Date:2012-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty