Statesville Amy Kinlaw PLLC

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

Legal business name

STATESVILLE AMY KINLAW PLLC

Doing business as

Iredell Pediatric Dentistry

Practice address

1316 Davie Ave Ste C
Statesville, NC 28677-3561

Phone

(828) 635-9200

NPI assigned

Oct 12, 2021

Last updated

Oct 12, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Karol Manchola

Title

Regional Manager

Phone

(828) 635-9200

Specialties & licenses 1

Addresses

Other names 1

• Iredell Pediatric Dentistry Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1633996800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633996800000",
    "number": "1629730130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "167 1ST AVE SW",
            "city": "TAYLORSVILLE",
            "state": "NC",
            "postal_code": "286812639",
            "telephone_number": "828-635-9200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1316 DAVIE AVE STE C",
            "city": "STATESVILLE",
            "state": "NC",
            "postal_code": "286773561",
            "telephone_number": "828-635-9200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATESVILLE AMY KINLAW PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-12",
        "last_updated": "2021-10-12",
        "certification_date": "2021-10-12",
        "status": "A",
        "authorized_official_last_name": "MANCHOLA",
        "authorized_official_first_name": "KAROL",
        "authorized_official_title_or_position": "REGIONAL MANAGER",
        "authorized_official_telephone_number": "828-635-9200"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Iredell Pediatric Dentistry",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hannah Jean St. John, LCSWA
• Benjamin Robert Stacy, D.O.
• Amy Stamper
• Adam Stapleton, PA-C
• Jessica Starr, ATC
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• Pediatric Dentistry in Statesville, NC
• Providers in Statesville, NC by specialty
• Pediatric Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.