Individual
KINNISON EDMUNDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11295 STONECREEK DR, PICKERINGTON, OH 43147-9138
(614) 864-3196
Mailing address
11 S MILL ST STE 200, NEW CASTLE, PA 16101-3680
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
30.025765
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30.025765
STATE LICENSE
OH
Enumeration date
05/21/2019
Last updated
06/11/2019
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