MEDICARE: DR. KIRK H KINNEY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	006465	VA

General Provider Information

NPI Number	:	1336232545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KIRK H KINNEY DDS

Provider Business Mailing Address
First Line	:	PO BOX A
Second Line	:
City	:	THE PLAINS
State	:	VA
Zip	:	20198
Country	:	US
Telephone Number	:	540-253-7403
Fax Number	:	540-253-7110

Provider Business Practice Location Address
First Line	:	6479 MAIN STREET
Second Line	:
City	:	THE PLAINS
State	:	VA
Zip	:	20198
Country	:	US
Telephone Number	:	540-253-7403
Fax Number	:	540-253-7110

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/02/2006
Last Update Date	:	07/08/2007

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