Provider Demographics
NPI:1508929084
Name:STACEY KINSEY, DMD PC
Entity Type:Organization
Organization Name:STACEY KINSEY, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:V
Authorized Official - Last Name:KOGLER
Authorized Official - Suffix:
Authorized Official - Credentials:FACMPE
Authorized Official - Phone:770-949-3797
Mailing Address - Street 1:6043 PRESTLEY MILL RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-2280
Mailing Address - Country:US
Mailing Address - Phone:770-949-3797
Mailing Address - Fax:770-949-9077
Practice Address - Street 1:6043 PRESTLEY MILL RD
Practice Address - Street 2:SUITE A
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-2280
Practice Address - Country:US
Practice Address - Phone:770-949-3797
Practice Address - Fax:770-949-9077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty