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Individual

DR. MICHAEL CLARK KINNEBREW

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D., D.D.S.

Contact information

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

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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