# MICHAEL C. KINNEBREW, MD, DDS, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1558533315
- **Authorized official:** MR. PAUL O BELISLE (CFO)
- **Authorized official phone:** (910) 762-2618

## Contact information

- **Practice address:** 1122 MEDICAL CENTER DR, WILMINGTON, NC 28401-7305
- **Practice address phone:** (910) 762-2618
- **Practice address fax:** (910) 763-5173
- **Mailing address:** 1122 MEDICAL CENTER DR, WILMINGTON, NC 28401-7305
- **Mailing address phone:** (910) 762-2618
- **Mailing address fax:** (910) 763-5173

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 96000154 | NC | Yes |

## Other

- **Enumeration date:** 04/01/2008
- **Last updated:** 04/01/2008