Provider Demographics
NPI:1649645714
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 1:9019 W BELDING RD
Mailing Address - Street 2:STE 2
Mailing Address - City:BELDING
Mailing Address - State:MI
Mailing Address - Zip Code:48809-9280
Mailing Address - Country:US
Mailing Address - Phone:616-794-0490
Mailing Address - Fax:616-794-3443
Practice Address - Street 1:9019 W BELDING RD
Practice Address - Street 2:STE 2
Practice Address - City:BELDING
Practice Address - State:MI
Practice Address - Zip Code:48809-9280
Practice Address - Country:US
Practice Address - Phone:616-794-0490
Practice Address - Fax:616-794-3443
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-01
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI198301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty