Provider Demographics
NPI:1629730130
Name:STATESVILLE AMY KINLAW PLLC
Entity Type:Organization
Organization Name:STATESVILLE AMY KINLAW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGIONAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCHOLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:828-635-9200
Mailing Address - Street 1:167 1ST AVE SW
Mailing Address - Street 2:
Mailing Address - City:TAYLORSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28681-2639
Mailing Address - Country:US
Mailing Address - Phone:828-635-9200
Mailing Address - Fax:
Practice Address - Street 1:1316 DAVIE AVE STE C
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-3561
Practice Address - Country:US
Practice Address - Phone:828-635-9200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty