Provider Demographics
NPI:1285630640
Name:MCGINNIS, KIM ALAN (DDS)
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:ALAN
Last Name:MCGINNIS
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 1:2121 MADISON ST
Mailing Address - Street 2:STE B
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98203-5375
Mailing Address - Country:US
Mailing Address - Phone:425-353-3210
Mailing Address - Fax:425-355-7426
Practice Address - Street 1:2121 MADISON ST
Practice Address - Street 2:STE B
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98203-5375
Practice Address - Country:US
Practice Address - Phone:425-353-3210
Practice Address - Fax:425-355-7426
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000057331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice