Provider Demographics
NPI:1881718922
Name:MURDOCH-KINCH, CAROLE ANNE (DDS)
Entity type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANNE
Last Name:MURDOCH-KINCH
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 1:1011 N UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-1078
Mailing Address - Country:US
Mailing Address - Phone:734-615-6948
Mailing Address - Fax:734-936-5955
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:B1B204
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-0018
Practice Address - Country:US
Practice Address - Phone:734-615-6948
Practice Address - Fax:734-936-5955
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901016430122300000X, 1223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1958163140OtherBCBS OF MI MED SURGICAL
MI4246420Medicaid
MID164300OtherBCBS OF MI DENTAL
MI4246439Medicaid
MID164300OtherBCBS OF MI DENTAL
MIV05014Medicare UPIN