Provider Demographics
NPI:1639313471
Name:KINLAW, AMY ANN (DMD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:ANN
Last Name:KINLAW
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1247 LAKEPOINTE LN
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-5734
Mailing Address - Country:US
Mailing Address - Phone:336-414-1013
Mailing Address - Fax:
Practice Address - Street 1:1247 LAKEPOINTE LN
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5734
Practice Address - Country:US
Practice Address - Phone:336-414-1013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-23
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN179881223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice