Provider Demographics
NPI:1487738340
Name:KANBAR, KINAN (DMD)
Entity type:Individual
Prefix:
First Name:KINAN
Middle Name:
Last Name:KANBAR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:296 GREAT RD
Mailing Address - Street 2:
Mailing Address - City:ACTON
Mailing Address - State:MA
Mailing Address - Zip Code:01720-4710
Mailing Address - Country:US
Mailing Address - Phone:978-263-8525
Mailing Address - Fax:978-263-2955
Practice Address - Street 1:296 GREAT RD
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4710
Practice Address - Country:US
Practice Address - Phone:978-263-8525
Practice Address - Fax:978-263-2955
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice