Provider Demographics
NPI:1962575993
Name:SMITH, KEVIN EARL (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EARL
Last Name:SMITH
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 1:2 E STREET RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-8412
Mailing Address - Country:US
Mailing Address - Phone:610-399-1080
Mailing Address - Fax:610-399-7989
Practice Address - Street 1:2 E STREET RD
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-8412
Practice Address - Country:US
Practice Address - Phone:610-399-1080
Practice Address - Fax:610-399-7989
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025396L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice