Provider Demographics
NPI:1992964126
Name:KEVIN HINTZ DDS, FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:KEVIN HINTZ DDS, FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:HINTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:208-457-8406
Mailing Address - Street 1:1206 N IDAHO ST
Mailing Address - Street 2:
Mailing Address - City:POST FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83854-5131
Mailing Address - Country:US
Mailing Address - Phone:208-457-8406
Mailing Address - Fax:208-457-9680
Practice Address - Street 1:1206 N IDAHO ST
Practice Address - Street 2:
Practice Address - City:POST FALLS
Practice Address - State:ID
Practice Address - Zip Code:83854-5131
Practice Address - Country:US
Practice Address - Phone:208-457-8406
Practice Address - Fax:208-457-9680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-03
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD38891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty