Provider Demographics
NPI:1538379441
Name:KINSEY, BRIAN THOMAS (DMD)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:THOMAS
Last Name:KINSEY
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 1:3325 VISTA CREEK DR
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4521
Mailing Address - Country:US
Mailing Address - Phone:678-714-0525
Mailing Address - Fax:
Practice Address - Street 1:3625 BRASELTON HWY STE 102
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4696
Practice Address - Country:US
Practice Address - Phone:678-714-0525
Practice Address - Fax:678-392-4767
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice