Provider Demographics
NPI:1316073158
Name:RAGSDALE, KEVIN LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LEE
Last Name:RAGSDALE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1501 BROADRICK DR
Mailing Address - Street 2:STE 2
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-3014
Mailing Address - Country:US
Mailing Address - Phone:706-275-6631
Mailing Address - Fax:706-226-4899
Practice Address - Street 1:1501 BROADRICK DR
Practice Address - Street 2:STE 2
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-3014
Practice Address - Country:US
Practice Address - Phone:706-275-6631
Practice Address - Fax:706-226-4899
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA101651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice