Provider Demographics
NPI:1306258298
Name:ALBERT, KEVIN MARK (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MARK
Last Name:ALBERT
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 1:1507 WILTON FARM RD
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22911-7648
Mailing Address - Country:US
Mailing Address - Phone:330-717-4633
Mailing Address - Fax:
Practice Address - Street 1:2320 COMMONWEALTH DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22901-1622
Practice Address - Country:US
Practice Address - Phone:434-978-1510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-27
Last Update Date:2014-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist