Provider Demographics
NPI:1326134271
Name:KINGRY, KEVIN FRANK (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:FRANK
Last Name:KINGRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ARCADE UNIT 198747
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37219-1994
Mailing Address - Country:US
Mailing Address - Phone:615-750-0343
Mailing Address - Fax:
Practice Address - Street 1:5412 MONTGOMERY HWY
Practice Address - Street 2:SUITE 8
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36303-1657
Practice Address - Country:US
Practice Address - Phone:334-983-1730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL51831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009910048Medicaid
GA148208632AMedicaid