Organization
MICHAEL C. KINNEBREW, MD, DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL O BELISLE (CFO)
(910) 762-2618
Entity
Organization
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
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
96000154
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
145230
GUARDIAN
NC
01
—
49309
BCBS
NC
05
—
8949309
—
NC
05
—
8994921
—
NC
01
—
979443
UCCI
NC
Enumeration date
04/01/2008
Last updated
04/01/2008
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