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NPI Code Detail

MEDICARE: ROBERT N KINSAUL DMD PC

MEDICARE: ROBERT N KINSAUL DMD PC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry3106AL

General Provider Information

NPI Number : 1215112941
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERT N KINSAUL DMD PC
Provider Business Mailing Address
First Line : 2409 SPORTSMAN DR
Second Line :
City : PHENIX CITY
State : AL
Zip : 36867-5402
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 2409 SPORTSMAN DR
Second Line :
City : PHENIX CITY
State : AL
Zip : 36867-5402
Country : US
Telephone Number : 334-297-5890
Fax Number :
Authorized Official
Title or Position : INSURANCE COORD
Name : CHERRI HALL
Credential :
Telephone Number : 334-297-5890
Provider Enumeration Date : 12/31/2007
Last Update Date : 12/31/2007

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