Healthcare Provider Details

I. General information

NPI: 1255796892
Provider Name (Legal Business Name): KINSER FAMILY DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 E HOWARD CITY EDMORE RD
EDMORE MI
48829-9737
US

IV. Provider business mailing address

1315 E HOWARD CITY EDMORE RD
EDMORE MI
48829-9737
US

V. Phone/Fax

Practice location:
  • Phone: 989-427-3430
  • Fax: 989-427-1204
Mailing address:
  • Phone: 989-427-3430
  • Fax: 989-427-1204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number19830
License Number StateMI

VIII. Authorized Official

Name: DR. SHAWN J KINSER
Title or Position: OWNER, DENTIST
Credential: DDS, PHD
Phone: 616-894-7703