Provider Demographics
NPI:1457628711
Name:CHRIS D. KINNEY, D.D.S. P.C.
Entity Type:Organization
Organization Name:CHRIS D. KINNEY, D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FRONT OFFICE
Authorized Official - Prefix:MRS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:E
Authorized Official - Last Name:MCFERRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-649-8118
Mailing Address - Street 1:3825 FAIRVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46013-4059
Mailing Address - Country:US
Mailing Address - Phone:765-649-8118
Mailing Address - Fax:765-649-8119
Practice Address - Street 1:3825 FAIRVIEW DR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46013-4059
Practice Address - Country:US
Practice Address - Phone:765-649-8118
Practice Address - Fax:765-649-8119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-30
Last Update Date:2011-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120087021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100172330AMedicaid
209620Medicare PIN
IN100172330AMedicaid