Provider Demographics
NPI:1265847388
Name:KINNO, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KINNO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:MUHANAD
Other - Middle Name:
Other - Last Name:KINNO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:806 W HAMLET AVE
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28345-2508
Mailing Address - Country:US
Mailing Address - Phone:910-582-5143
Mailing Address - Fax:910-582-8620
Practice Address - Street 1:806 W HAMLET AVE
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-2508
Practice Address - Country:US
Practice Address - Phone:910-582-5143
Practice Address - Fax:910-582-8620
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist