Provider Demographics
NPI:1023271038
Name:KINSER, SHAWN (DDS PHD)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:
Last Name:KINSER
Suffix:
Gender:M
Credentials:DDS PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 E HOWARD CITY EDMORE RD
Mailing Address - Street 2:
Mailing Address - City:EDMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48829-9737
Mailing Address - Country:US
Mailing Address - Phone:989-427-3430
Mailing Address - Fax:
Practice Address - Street 1:1315 E HOWARD CITY EDMORE RD
Practice Address - Street 2:
Practice Address - City:EDMORE
Practice Address - State:MI
Practice Address - Zip Code:48829-9737
Practice Address - Country:US
Practice Address - Phone:989-427-3430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010198301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice