MEDICARE: DR. BRUCE PAUL KINNEY D.D.S.

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
1	1223G0001X	General Practice Dentistry	DE00005448	WA

General Provider Information

NPI Number	:	1356346555
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE PAUL KINNEY D.D.S.

Provider Business Mailing Address
First Line	:	1014 S 40TH AVE
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98908-3804
Country	:	US
Telephone Number	:	509-972-8338
Fax Number	:	509-972-8356

Provider Business Practice Location Address
First Line	:	1014 S 40TH AVE
Second Line	:
City	:	YAKIMA
State	:	WA
Zip	:	98908-3804
Country	:	US
Telephone Number	:	509-972-8338
Fax Number	:	509-972-8356

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/08/2007

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