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Individual
DR. MICHAEL CLARK KINNEBREW
Active
Individual
DR. MICHAEL CLARK KINNEBREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D., D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
1223P0106X
Oral and Maxillofacial Pathology Dentistry
Primary
96000154
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10272203
VOCATIONAL REHABILITATION
NC
01
—
49309
BLUE CROSS BLUE SHIELD
NC
05
—
8949309
—
NC
05
—
8994921
—
NC
01
—
979443
UNITED CONCORDIA
—
Enumeration date
10/10/2005
Last updated
02/01/2011
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