Provider Demographics
NPI:1629412200
Name:TINER, DARIN FREDERICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:DARIN
Middle Name:FREDERICK
Last Name:TINER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:398 192ND ARMORED TANK BN RD
Mailing Address - Street 2:US ARMY DENTAL ACTIVITY
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5116
Mailing Address - Country:US
Mailing Address - Phone:502-624-6158
Mailing Address - Fax:502-624-2966
Practice Address - Street 1:398 192ND ARMORED TANK BN RD
Practice Address - Street 2:US ARMY DENTAL ACTIVITY
Practice Address - City:FORT KNOX
Practice Address - State:KY
Practice Address - Zip Code:40121-5116
Practice Address - Country:US
Practice Address - Phone:502-624-6158
Practice Address - Fax:502-624-2966
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8327153-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice