Provider Demographics
NPI:1235622507
Name:AUDREY KINDER DMD PLLC
Entity Type:Organization
Organization Name:AUDREY KINDER DMD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:KINDER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-269-9443
Mailing Address - Street 1:121 W VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-1661
Mailing Address - Country:US
Mailing Address - Phone:606-337-3034
Mailing Address - Fax:
Practice Address - Street 1:121 W VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-1661
Practice Address - Country:US
Practice Address - Phone:606-337-3034
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-12
Last Update Date:2018-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10120261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental