Provider Demographics
NPI:1407061286
Name:J. JEFF KINCAID, DMD, MS
Entity Type:Organization
Organization Name:J. JEFF KINCAID, DMD, MS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:JEFFREY
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MS
Authorized Official - Phone:770-516-5773
Mailing Address - Street 1:355 PARKWAY 575
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30188-3882
Mailing Address - Country:US
Mailing Address - Phone:770-516-5773
Mailing Address - Fax:770-516-5779
Practice Address - Street 1:355 PARKWAY 575
Practice Address - Street 2:SUITE 200
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30188-3882
Practice Address - Country:US
Practice Address - Phone:770-516-5773
Practice Address - Fax:770-516-5779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0102241223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty