Provider Demographics
NPI:1083629760
Name:KINES, DON W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:W
Last Name:KINES
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:PO BOX 217
Mailing Address - Street 2:
Mailing Address - City:DAVIS
Mailing Address - State:WV
Mailing Address - Zip Code:26260-0217
Mailing Address - Country:US
Mailing Address - Phone:304-259-5225
Mailing Address - Fax:304-259-5226
Practice Address - Street 1:217 WILLIAM AVE
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:WV
Practice Address - Zip Code:26260-0217
Practice Address - Country:US
Practice Address - Phone:304-259-5225
Practice Address - Fax:304-259-5226
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3080122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134552000Medicaid