Provider Demographics
NPI:1700997376
Name:KINSEY, STEPHANIE L (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:L
Last Name:KINSEY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 PALENCIA VILLAGE DR
Mailing Address - Street 2:SUITE 107-109
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32095-8457
Mailing Address - Country:US
Mailing Address - Phone:904-826-4343
Mailing Address - Fax:904-826-4335
Practice Address - Street 1:159 PALENCIA VILLAGE DR
Practice Address - Street 2:SUITE 107-109
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32095-8457
Practice Address - Country:US
Practice Address - Phone:904-826-4343
Practice Address - Fax:904-826-4335
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN172511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice