Provider Demographics
NPI:1750491510
Name:KINCAID, MICHAEL W (DDS)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:W
Last Name:KINCAID
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 1:3600 OLENTANGY RIVER RD
Mailing Address - Street 2:STE C-4
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-3437
Mailing Address - Country:US
Mailing Address - Phone:614-457-8400
Mailing Address - Fax:614-451-7474
Practice Address - Street 1:3600 OLENTANGY RIVER RD
Practice Address - Street 2:STE C-4
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-3437
Practice Address - Country:US
Practice Address - Phone:614-457-8400
Practice Address - Fax:614-457-7474
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2013-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300212351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice