Provider Demographics
NPI:1003835992
Name:KLINEDINST, KEVIN L (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:L
Last Name:KLINEDINST
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 1:110 MILES RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-2410
Mailing Address - Country:US
Mailing Address - Phone:812-273-4524
Mailing Address - Fax:812-273-5745
Practice Address - Street 1:110 MILES RIDGE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2410
Practice Address - Country:US
Practice Address - Phone:812-273-4524
Practice Address - Fax:812-273-5745
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN86451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice