Provider Demographics
NPI:1821269408
Name:KISINGER, KENNETH CHARLES (DMD)
Entity Type:Individual
Prefix:
First Name:KENNETH
Middle Name:CHARLES
Last Name:KISINGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:899 N WILMOT RD
Mailing Address - Street 2:SUITE E1
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-1713
Mailing Address - Country:US
Mailing Address - Phone:520-747-1611
Mailing Address - Fax:520-747-1612
Practice Address - Street 1:899 N WILMOT RD
Practice Address - Street 2:SUITE E1
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-1713
Practice Address - Country:US
Practice Address - Phone:520-747-1611
Practice Address - Fax:520-747-1612
Is Sole Proprietor?:No
Enumeration Date:2008-03-21
Last Update Date:2008-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice