Provider Demographics
NPI:1770784183
Name:DELMA H. KINLAW, DDS, PA
Entity type:Organization
Organization Name:DELMA H. KINLAW, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:SEVERT
Authorized Official - Last Name:BODDORF
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, MED
Authorized Official - Phone:919-859-6633
Mailing Address - Street 1:251 KEISLER DRIVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27518-7091
Mailing Address - Country:US
Mailing Address - Phone:919-859-6633
Mailing Address - Fax:919-859-6644
Practice Address - Street 1:251 KEISLER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-7091
Practice Address - Country:US
Practice Address - Phone:919-859-6633
Practice Address - Fax:919-859-6644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC49161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty