Provider Demographics
NPI:1679589618
Name:KINSEL, JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:
Last Name:KINSEL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3560 OLD HIGHWAY 53
Mailing Address - Street 2:
Mailing Address - City:CLEARLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95422-9251
Mailing Address - Country:US
Mailing Address - Phone:707-994-9414
Mailing Address - Fax:707-994-6328
Practice Address - Street 1:3560 OLD HIGHWAY 53
Practice Address - Street 2:
Practice Address - City:CLEARLAKE
Practice Address - State:CA
Practice Address - Zip Code:95422-9251
Practice Address - Country:US
Practice Address - Phone:707-994-9414
Practice Address - Fax:707-994-6328
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45720122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist