Provider Demographics
NPI:1730270703
Name:KINES-MCLEOD, GWENDOLYN DAWN (DDS)
Entity type:Individual
Prefix:DR
First Name:GWENDOLYN
Middle Name:DAWN
Last Name:KINES-MCLEOD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:GWENDOLYN
Other - Middle Name:DAWN
Other - Last Name:KINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:401 N ANN ST STE B
Mailing Address - Street 2:
Mailing Address - City:TERRELL
Mailing Address - State:TX
Mailing Address - Zip Code:75160-2549
Mailing Address - Country:US
Mailing Address - Phone:972-524-5347
Mailing Address - Fax:972-524-2142
Practice Address - Street 1:401 N ANN ST
Practice Address - Street 2:B
Practice Address - City:TERRELL
Practice Address - State:TX
Practice Address - Zip Code:75160-2549
Practice Address - Country:US
Practice Address - Phone:972-524-5347
Practice Address - Fax:972-524-2142
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1784944-01Medicaid