Provider Demographics
NPI:1790278547
Name:KINDER, AUDREY CRAIG (DMD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:CRAIG
Last Name:KINDER
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 1:10156 US HIGHWAY 25 E
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977-8584
Mailing Address - Country:US
Mailing Address - Phone:606-337-3034
Mailing Address - Fax:606-337-5305
Practice Address - Street 1:10156 US HIGHWAY 25 E
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977-8584
Practice Address - Country:US
Practice Address - Phone:606-337-3034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice