Provider Demographics
NPI:1104947019
Name:KAISER, JINA LYNN (DDS)
Entity type:Individual
Prefix:DR
First Name:JINA
Middle Name:LYNN
Last Name:KAISER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8222 DOUGLAS AVE STE 880
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75225-5936
Mailing Address - Country:US
Mailing Address - Phone:214-750-6106
Mailing Address - Fax:214-750-4566
Practice Address - Street 1:8222 DOUGLAS AVE STE 880
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75225-5936
Practice Address - Country:US
Practice Address - Phone:214-750-6106
Practice Address - Fax:214-750-4566
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165131223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice