Provider Demographics
NPI:1821094434
Name:KINCHELOE, ALLEN C (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:C
Last Name:KINCHELOE
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 1:12110 MURPHY RD
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-2405
Mailing Address - Country:US
Mailing Address - Phone:281-495-9300
Mailing Address - Fax:281-495-6010
Practice Address - Street 1:12110 MURPHY RD
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-2405
Practice Address - Country:US
Practice Address - Phone:281-495-9300
Practice Address - Fax:281-495-6010
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX107171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice