Healthcare Provider Details

I. General information

NPI: 1528127214
Provider Name (Legal Business Name): GREGORY E KINSINGER JR. DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8373 WAYNESBURG DR SE
WAYNESBURG OH
44688
US

IV. Provider business mailing address

8373 WAYNESBURG DR. SE
WAYNESBURG OH
44688
US

V. Phone/Fax

Practice location:
  • Phone: 330-866-3507
  • Fax:
Mailing address:
  • Phone: 330-866-3507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30022404
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: