Provider Demographics
NPI:1083287882
Name:XAVIER, KINNY (DDS)
Entity Type:Individual
Prefix:
First Name:KINNY
Middle Name:
Last Name:XAVIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2219 PARK HURST DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-5640
Mailing Address - Country:US
Mailing Address - Phone:817-689-0924
Mailing Address - Fax:
Practice Address - Street 1:1809 TULANE DR
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75901-5637
Practice Address - Country:US
Practice Address - Phone:936-225-3544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37566122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist