Provider Demographics
NPI:1063698918
Name:KEVIN J DILEO DDS EVIE GREEN-DILEO DDS PC
Entity type:Organization
Organization Name:KEVIN J DILEO DDS EVIE GREEN-DILEO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DILEO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:409-886-9392
Mailing Address - Street 1:1208 W ELM ST
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:TX
Mailing Address - Zip Code:77630-5535
Mailing Address - Country:US
Mailing Address - Phone:409-886-9392
Mailing Address - Fax:409-883-6811
Practice Address - Street 1:1208 W ELM ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:TX
Practice Address - Zip Code:77630-5535
Practice Address - Country:US
Practice Address - Phone:409-886-9392
Practice Address - Fax:409-883-6811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169061223G0001X
TX169001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0027B2OtherBLUE CROSS BLUE SHIELD