Provider Demographics
NPI:1326190299
Name:KINNEY, JR., GEORGE J (DDS)
Entity type:Individual
Prefix:
First Name:GEORGE
Middle Name:J
Last Name:KINNEY, JR.
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 RADIO DR
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-8409
Mailing Address - Country:US
Mailing Address - Phone:651-739-1894
Mailing Address - Fax:651-739-5496
Practice Address - Street 1:1000 RADIO DR
Practice Address - Street 2:SUITE 240
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-8409
Practice Address - Country:US
Practice Address - Phone:651-739-1894
Practice Address - Fax:651-739-5496
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN74301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice