Provider Demographics
NPI:1679653117
Name:KVINSLAND, JON H (DDS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:H
Last Name:KVINSLAND
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 1:5122 OLYMPIC DR NW
Mailing Address - Street 2:SUITE A-201
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1767
Mailing Address - Country:US
Mailing Address - Phone:253-851-9171
Mailing Address - Fax:253-851-9194
Practice Address - Street 1:5122 OLYMPIC DR NW
Practice Address - Street 2:SUITE A-201
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1767
Practice Address - Country:US
Practice Address - Phone:253-851-9171
Practice Address - Fax:253-851-9194
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice