Healthcare Provider Details

I. General information

NPI: 1154470920
Provider Name (Legal Business Name): TODD CANDLER KINCER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 11/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 MULBERRY ST SW
LENOIR NC
28645-5721
US

IV. Provider business mailing address

115 ISLAND RIDGE DR
STATESVILLE NC
28677-2097
US

V. Phone/Fax

Practice location:
  • Phone: 828-754-7881
  • Fax:
Mailing address:
  • Phone: 704-528-8340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number8154
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: