Provider Demographics
NPI:1235425133
Name:KINSLOW, CHRISTOPHER MATTHEW (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:MATTHEW
Last Name:KINSLOW
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06513-3723
Mailing Address - Country:US
Mailing Address - Phone:203-691-6145
Mailing Address - Fax:
Practice Address - Street 1:262 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3723
Practice Address - Country:US
Practice Address - Phone:203-691-6145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT108211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice