Healthcare Provider Details

I. General information

NPI: 1770191421
Provider Name (Legal Business Name): AMY ANN KINLAW DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 1ST AVE SW
TAYLORSVILLE NC
28681-2639
US

IV. Provider business mailing address

8631 ARBOR CREEK DR STE D3
CHARLOTTE NC
28269-0548
US

V. Phone/Fax

Practice location:
  • Phone: 828-635-9200
  • Fax:
Mailing address:
  • Phone: 704-875-9075
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VIII. Authorized Official

Name: KAROL MANCHOLA
Title or Position: REGIONAL MANAGER
Credential:
Phone: 980-875-9158