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General NPI Number Information
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NPI Number | 1770191421
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Entity Type | Organization
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Legal Business Name | AMY ANN KINLAW DMD PLLC
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Dates
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Enumeration Date | 07/20/2020
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Last Update Date | 05/06/2021
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Provider Practice Location Address
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Address Line | 167 1ST AVE SW
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City | TAYLORSVILLE
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State | NC
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Zip | 28681-2639
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Country | US
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Telephone | 828-635-9200
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Fax |
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Provider Business Mailing Address
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Address Line | 8631 ARBOR CREEK DR STE D3
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City | CHARLOTTE
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State | NC
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Zip | 28269-0548
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Country | US
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Telephone | 704-875-9075
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Fax |
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Authorized Official
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Title or Position | REGIONAL MANAGER
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Name | KAROL MANCHOLA
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Credential |
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Telephone | 980-875-9158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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