Provider Demographics
NPI:1992068860
Name:KIDDER, KEVIN ALLEN (DDS)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALLEN
Last Name:KIDDER
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 1:260 S ALEXANDER AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ALLEN
Mailing Address - State:LA
Mailing Address - Zip Code:70767-3016
Mailing Address - Country:US
Mailing Address - Phone:225-372-8716
Mailing Address - Fax:
Practice Address - Street 1:260 S ALEXANDER AVE
Practice Address - Street 2:
Practice Address - City:PORT ALLEN
Practice Address - State:LA
Practice Address - Zip Code:70767-3016
Practice Address - Country:US
Practice Address - Phone:225-372-8716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-16
Last Update Date:2012-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA62771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice