Provider Demographics
NPI:1356556047
Name:KINNEY, THEODORE C (DDS)
Entity type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:C
Last Name:KINNEY
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 1:502 WICKS LN
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-4432
Mailing Address - Country:US
Mailing Address - Phone:406-248-7868
Mailing Address - Fax:406-248-1768
Practice Address - Street 1:502 WICKS LN
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-4432
Practice Address - Country:US
Practice Address - Phone:406-248-7868
Practice Address - Fax:406-248-1768
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice