Provider Demographics
NPI:1679337497
Name:KINNAMAN, BILLY EUGENE JR
Entity Type:Individual
Prefix:MR
First Name:BILLY
Middle Name:EUGENE
Last Name:KINNAMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4070 STANLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78234-2714
Mailing Address - Country:US
Mailing Address - Phone:210-589-9180
Mailing Address - Fax:
Practice Address - Street 1:3145 GARDEN AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78234-7718
Practice Address - Country:US
Practice Address - Phone:210-598-9180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant