Provider Demographics
NPI:1598828063
Name:KINSEY, RICHARD W (DMD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:W
Last Name:KINSEY
Suffix:
Gender:M
Credentials:DMD
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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
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0090631223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA009063OtherDENTAL LICENSE
U12633Medicare UPIN