MEDICARE: RICHARD J. KINCAID DDS,PA

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	261QD0000X	Dental Clinic/Center	4079	NC

General Provider Information

NPI Number	:	1407022742
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RICHARD J. KINCAID DDS,PA

Provider Business Mailing Address
First Line	:	3749 LATROBE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1164
Country	:	US
Telephone Number	:	704-365-0006
Fax Number	:	704-365-0007

Provider Business Practice Location Address
First Line	:	3749 LATROBE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28211-1164
Country	:	US
Telephone Number	:	704-365-0006
Fax Number	:	704-365-0007

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD J. KINCAID
Credential	:	DDS
Telephone Number	:	704-365-0006

Provider Enumeration Date	:	05/06/2008
Last Update Date	:	05/06/2008

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