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General NPI Number Information
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NPI Number | 1508929084
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Entity Type | Organization
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Legal Business Name | STACEY KINSEY, DMD PC
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6043 PRESTLEY MILL RD SUITE A
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-2280
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Country | US
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Telephone | 770-949-3797
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Fax | 770-949-9077
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Provider Business Mailing Address
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Address Line | 6043 PRESTLEY MILL RD SUITE A
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City | DOUGLASVILLE
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State | GA
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Zip | 30134-2280
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Country | US
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Telephone | 770-949-3797
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Fax | 770-949-9077
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MR. CHARLES V. KOGLER
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Credential | FACMPE
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Telephone | 770-949-3797
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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 |
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License Number State |
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