Provider Demographics
NPI:1386767325
Name:KINSEY, FRED D (DDS)
Entity type:Individual
Prefix:DR
First Name:FRED
Middle Name:D
Last Name:KINSEY
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 1:229 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTER
Mailing Address - State:WV
Mailing Address - Zip Code:26034-1112
Mailing Address - Country:US
Mailing Address - Phone:304-387-2822
Mailing Address - Fax:304-387-3812
Practice Address - Street 1:229 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:WV
Practice Address - Zip Code:26034-1112
Practice Address - Country:US
Practice Address - Phone:304-387-2822
Practice Address - Fax:304-387-3812
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV28341223G0001X
OH180801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice