Healthcare Provider Details

I. General information

NPI: 1336498039
Provider Name (Legal Business Name): GREGORY E. KINSINGER, D.D.S., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2012
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8373 WAYNESBURG DR SE
WAYNESBURG OH
44688-9538
US

IV. Provider business mailing address

8373 WAYNESBURG DR SE
WAYNESBURG OH
44688-9538
US

V. Phone/Fax

Practice location:
  • Phone: 330-866-3507
  • Fax: 330-866-4370
Mailing address:
  • Phone: 330-866-3507
  • Fax: 330-866-4370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-022404
License Number StateOH

VIII. Authorized Official

Name: DR. GREGORY E KINSINGER
Title or Position: DENTIST/PRESIDENT
Credential: DDS
Phone: 330-866-3507