Provider Demographics
NPI:1477727394
Name:MICHAEL A. KINCAID, D.D.S.
Entity Type:Organization
Organization Name:MICHAEL A. KINCAID, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KINCAID
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:918-258-8515
Mailing Address - Street 1:1402 S ASPEN AVE
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-4807
Mailing Address - Country:US
Mailing Address - Phone:918-258-8515
Mailing Address - Fax:918-251-5463
Practice Address - Street 1:1402 S ASPEN AVE
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4807
Practice Address - Country:US
Practice Address - Phone:918-258-8515
Practice Address - Fax:918-251-5463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4037261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental