Provider Demographics
NPI:1255796892
Name:KINSER FAMILY DENTISTRY, LLC
Entity type:Organization
Organization Name:KINSER FAMILY DENTISTRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER, DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KINSER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PHD
Authorized Official - Phone:616-894-7703
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:989-427-1204
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:989-427-1204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2015-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI198301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty