Provider Demographics
NPI:1083022263
Name:DEMING CHILDREN'S DENTISTRY
Entity Type:Organization
Organization Name:DEMING CHILDREN'S DENTISTRY
Other - Org Name:DEMING CHILDREN'S DENTISTRY
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KYE
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:KINZER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:505-892-9010
Mailing Address - Street 1:8201 GOLF COURSE RD NW STE C3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-5805
Mailing Address - Country:US
Mailing Address - Phone:505-892-9010
Mailing Address - Fax:505-899-4804
Practice Address - Street 1:8201 GOLFCOURSE RD NW C-3
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120
Practice Address - Country:US
Practice Address - Phone:505-892-9010
Practice Address - Fax:505-899-4804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-31
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4143122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty