Provider Demographics
NPI:1164596623
Name:KINER, SAMUEL ROBERT (DDS)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:ROBERT
Last Name:KINER
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 1:1130 STRATHAVEN DR N
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-1902
Mailing Address - Country:US
Mailing Address - Phone:614-561-6194
Mailing Address - Fax:
Practice Address - Street 1:121 BROADWAY E
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1303
Practice Address - Country:US
Practice Address - Phone:740-587-4891
Practice Address - Fax:740-587-0198
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30016673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist