Provider Demographics
NPI:1861549354
Name:KINNARD, TIMOTHY EZEAL (DDS)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:EZEAL
Last Name:KINNARD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 54918
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73154-1918
Mailing Address - Country:US
Mailing Address - Phone:405-524-7214
Mailing Address - Fax:405-524-7217
Practice Address - Street 1:701 NE 36TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73105-7203
Practice Address - Country:US
Practice Address - Phone:405-524-7214
Practice Address - Fax:405-524-7217
Is Sole Proprietor?:No
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5485122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK12OtherDENTAL PRACTICE