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NPI Code Detail

MEDICARE: DR. TIMOTHY EZEAL KINNARD D.D.S.

MEDICARE: DR. TIMOTHY EZEAL KINNARD 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
1122300000XDentist5485OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
112OTHEROKDENTAL PRACTICE

General Provider Information

NPI Number : 1861549354
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY EZEAL KINNARD D.D.S.
Provider Business Mailing Address
First Line : PO BOX 54918
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73154-1918
Country : US
Telephone Number : 405-524-7214
Fax Number : 405-524-7217
Provider Business Practice Location Address
First Line : 701 NE 36TH ST
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73105-7203
Country : US
Telephone Number : 405-524-7214
Fax Number : 405-524-7217
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2007
Last Update Date : 07/08/2007

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Directions to “ DR. TIMOTHY EZEAL KINNARD D.D.S.” Practice Location

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