Provider Demographics
NPI:1275193278
Name:STEPHANIE KINSEY DDS
Entity Type:Organization
Organization Name:STEPHANIE KINSEY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KINSEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:904-826-4343
Mailing Address - Street 1:159 PALENCIA VILLAGE DR STE 107-109
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8457
Mailing Address - Country:US
Mailing Address - Phone:904-826-4343
Mailing Address - Fax:
Practice Address - Street 1:159 PALENCIA VILLAGE DR STE 107-109
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8457
Practice Address - Country:US
Practice Address - Phone:904-826-4343
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental