Provider Demographics
NPI:1346387214
Name:KINSER, CORBIN MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:CORBIN
Middle Name:MICHAEL
Last Name:KINSER
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 1:1211 14TH ST
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-1005
Mailing Address - Country:US
Mailing Address - Phone:209-577-6649
Mailing Address - Fax:
Practice Address - Street 1:1211 14TH ST
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-1005
Practice Address - Country:US
Practice Address - Phone:209-577-6649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA381971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice