Healthcare Provider Details

I. General information

NPI: 1083629760
Provider Name (Legal Business Name): DON W KINES DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

217 WILLIAM AVE
DAVIS WV
26260-0217
US

IV. Provider business mailing address

PO BOX 217
DAVIS WV
26260-0217
US

V. Phone/Fax

Practice location:
  • Phone: 304-259-5225
  • Fax: 304-259-5226
Mailing address:
  • Phone: 304-259-5225
  • Fax: 304-259-5226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number3080
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: