Provider Demographics
NPI:1538137187
Name:KINCAID, CHARLES L (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:KINCAID
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3745
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-0745
Mailing Address - Country:US
Mailing Address - Phone:785-843-4559
Mailing Address - Fax:785-843-1218
Practice Address - Street 1:306 E 23RD ST
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-4801
Practice Address - Country:US
Practice Address - Phone:785-843-4559
Practice Address - Fax:785-843-1218
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-09
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS52721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
12985022OtherBCBSKC
KS100096960AMedicaid
116696OtherBCBSKS
21647OtherUNITED CONCORDIA