Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 3170 | AZ |
NPI | 1235210857 |
---|---|
Provider Name | Dr. Michael L Kincaid |
First Address | Phoenix, AZ 85016-5319 |
Second Address | Phoenix, AZ 85016-5319 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 17/03/2018 |