Provider Demographics
NPI:1528094067
Name:DONLY, KEVIN JAMES (DDS)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:JAMES
Last Name:DONLY
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:P.O. BOX 40397
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3900
Mailing Address - Country:US
Mailing Address - Phone:210-567-3274
Mailing Address - Fax:210-567-2844
Practice Address - Street 1:7703 FLOYD CURL DR.
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3900
Practice Address - Country:US
Practice Address - Phone:210-567-3274
Practice Address - Fax:210-567-2844
Is Sole Proprietor?:No
Enumeration Date:2006-06-25
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15235122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120843107Medicaid
TX15235OtherTEXAS DENTAL LICENSE
84D665OtherBCBS
TX120843110Medicaid
TX120843108Medicaid
TX120843104Medicaid
T89614Medicare UPIN