Provider Demographics
NPI:1588702666
Name:STEPHENS, KEVIN C (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:C
Last Name:STEPHENS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N YARNALLTON PIKE
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40511-9092
Mailing Address - Country:US
Mailing Address - Phone:859-381-1348
Mailing Address - Fax:
Practice Address - Street 1:42 MCGINNIS DR
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:WV
Practice Address - Zip Code:25570-9553
Practice Address - Country:US
Practice Address - Phone:304-272-5136
Practice Address - Fax:304-272-3807
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300238991223G0001X
WV42331223G0001X
KY67801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810026312Medicaid
OH0088555Medicaid
KY60067808Medicaid
KYK177760Medicare PIN