Provider Demographics
NPI:1407924509
Name:KINNEY, LAURA M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:M
Last Name:KINNEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 FRANCE AVE S
Mailing Address - Street 2:STE 415
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-1805
Mailing Address - Country:US
Mailing Address - Phone:952-224-9785
Mailing Address - Fax:952-224-9790
Practice Address - Street 1:97 85TH AVE NW
Practice Address - Street 2:
Practice Address - City:COON RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55433-6022
Practice Address - Country:US
Practice Address - Phone:952-224-9785
Practice Address - Fax:952-224-9790
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11717122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN245994900Medicaid