Provider Demographics
NPI:1295710226
Name:KAMINSKE, KEVIN S (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:S
Last Name:KAMINSKE
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 1:43 SMITH ROAD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:RI
Mailing Address - Zip Code:02841-1002
Mailing Address - Country:US
Mailing Address - Phone:401-841-4522
Mailing Address - Fax:401-841-4128
Practice Address - Street 1:ONE AYERS CIRCLE
Practice Address - Street 2:BLDG H1
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03804-5000
Practice Address - Country:US
Practice Address - Phone:207-438-1130
Practice Address - Fax:207-438-2438
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0398641122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN