Provider Demographics
NPI:1700146453
Name:KINDERKNECHT, JONATHAN JAMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:JAMES
Last Name:KINDERKNECHT
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 1:2770 HALL ST
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-1815
Mailing Address - Country:US
Mailing Address - Phone:785-623-4441
Mailing Address - Fax:785-623-4442
Practice Address - Street 1:2770 HALL ST
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-1815
Practice Address - Country:US
Practice Address - Phone:785-623-4441
Practice Address - Fax:785-623-4442
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-29
Last Update Date:2012-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60813122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist