Provider Demographics
NPI:1699765289
Name:KINYON, TERENCE JAY (DDS)
Entity type:Individual
Prefix:
First Name:TERENCE
Middle Name:JAY
Last Name:KINYON
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 1:101 VANDENBERG AVE
Mailing Address - Street 2:
Mailing Address - City:BARKSDALE AFB
Mailing Address - State:LA
Mailing Address - Zip Code:71110-2003
Mailing Address - Country:US
Mailing Address - Phone:318-752-8539
Mailing Address - Fax:
Practice Address - Street 1:1067 TWINING DR
Practice Address - Street 2:
Practice Address - City:BARKSDALE AFB
Practice Address - State:LA
Practice Address - Zip Code:71110-2486
Practice Address - Country:US
Practice Address - Phone:318-456-6697
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5663122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist