MEDICARE: DR. CHARLES L KINCAID DDS

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	5272	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	12985022	OTHER	BCBSKC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	116696	OTHER	BCBSKS
4	21647	OTHER	UNITED CONCORDIA

General Provider Information

NPI Number	:	1538137187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES L KINCAID DDS

Provider Business Mailing Address
First Line	:	PO BOX 3745
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-0745
Country	:	US
Telephone Number	:	785-843-4559
Fax Number	:	785-843-1218

Provider Business Practice Location Address
First Line	:	306 E 23RD ST
Second Line	:
City	:	LAWRENCE
State	:	KS
Zip	:	66046-4801
Country	:	US
Telephone Number	:	785-843-4559
Fax Number	:	785-843-1218

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	10/06/2017

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