Provider Demographics
NPI:1790922854
Name:KINNEY & MUSSER, D.D.S.,P.A.
Entity Type:Organization
Organization Name:KINNEY & MUSSER, D.D.S.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.D.S.
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINNEY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:651-739-1894
Mailing Address - Street 1:1000 RADIO DR
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8409
Mailing Address - Country:US
Mailing Address - Phone:651-739-1894
Mailing Address - Fax:651-739-5496
Practice Address - Street 1:1000 RADIO DR
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8409
Practice Address - Country:US
Practice Address - Phone:651-739-1894
Practice Address - Fax:651-739-5496
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty