Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | RK015332 | MI |
NPI | 1003908575 |
---|---|
Provider Name | Dr. Robert L Kintz |
First Address | Ada, MI 49301-9591 |
Second Address | Grand Rapids, MI 49546-6111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 23/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U44774 | (02) | MI |