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General NPI Number Information
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NPI Number | 1043267925
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Entity Type | Organization
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Legal Business Name | KINCAID, MCCLARY & KIM D.D.S, P.S.
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16410 SMOKEY POINT BLVD SUITE 103
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City | ARLINGTON
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State | WA
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Zip | 98223-8415
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Country | US
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Telephone | 360-658-8822
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Fax | 360-659-1275
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Provider Business Mailing Address
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Address Line | 16410 SMOKEY POINT BLVD
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City | ARLINGTON
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State | WA
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Zip | 98223-8415
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Country | US
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Telephone | 360-658-8822
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Fax | 360-659-1275
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Authorized Official
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Title or Position | ADMINISTRATION
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Name | MS. DIANA LYNN PLYMALE
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Credential |
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Telephone | 360-651-1359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | GA10000027
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE00005524
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | GA10000031
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE0008656
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | GA10000282
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License Number State | WA
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Taxonomy #6
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | DE00003702
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License Number State | WA
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