Provider Demographics
NPI:1942423611
Name:KINKADE, DONALD JAMES (DDS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:JAMES
Last Name:KINKADE
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 1:2525 W 16TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-4903
Mailing Address - Country:US
Mailing Address - Phone:970-352-2344
Mailing Address - Fax:970-352-2001
Practice Address - Street 1:2525 W 16TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-4903
Practice Address - Country:US
Practice Address - Phone:970-352-2344
Practice Address - Fax:970-352-2001
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice