Provider Demographics
NPI:1003967068
Name:ALTIERI, KEVIN M (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:M
Last Name:ALTIERI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:M
Other - Last Name:MARTINEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:5521 BELLAIRE DR S
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-8838
Mailing Address - Country:US
Mailing Address - Phone:817-294-5513
Mailing Address - Fax:
Practice Address - Street 1:5521 BELLAIRE DR S
Practice Address - Street 2:SUITE202
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-8838
Practice Address - Country:US
Practice Address - Phone:817-294-5513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX169501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice