Provider Demographics
NPI:1770151847
Name:KRINGLE, KASEY STATEN (DMD)
Entity type:Individual
Prefix:DR
First Name:KASEY
Middle Name:STATEN
Last Name:KRINGLE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KASEY
Other - Middle Name:ELIZABETH
Other - Last Name:STATEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1196 MORRISON DR
Mailing Address - Street 2:
Mailing Address - City:GRENADA
Mailing Address - State:MS
Mailing Address - Zip Code:38901-5518
Mailing Address - Country:US
Mailing Address - Phone:662-614-1273
Mailing Address - Fax:
Practice Address - Street 1:4400 MCINNIS AVE
Practice Address - Street 2:
Practice Address - City:MOSS POINT
Practice Address - State:MS
Practice Address - Zip Code:39563-2814
Practice Address - Country:US
Practice Address - Phone:228-475-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-15
Last Update Date:2023-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS4215-211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice