Provider Demographics
NPI:1972250249
Name:RAHN, KEVIN MICHAEL (DMD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MICHAEL
Last Name:RAHN
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 1:3829 WINCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:PETERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16669-2820
Mailing Address - Country:US
Mailing Address - Phone:814-571-7147
Mailing Address - Fax:
Practice Address - Street 1:31 NE STATE ROUTE 300 STE 200
Practice Address - Street 2:
Practice Address - City:BELFAIR
Practice Address - State:WA
Practice Address - Zip Code:98528-8668
Practice Address - Country:US
Practice Address - Phone:360-377-3776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-07
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE613973871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice