Provider Demographics
NPI:1003987884
Name:EATMON, KEVIN GERNON (DDS)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:GERNON
Last Name:EATMON
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:2931 GREY MOSS PASS
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30097-6274
Mailing Address - Country:US
Mailing Address - Phone:404-254-0149
Mailing Address - Fax:404-254-0847
Practice Address - Street 1:275 14TH ST NW STE 100
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-9100
Practice Address - Country:US
Practice Address - Phone:404-254-0149
Practice Address - Fax:404-254-0847
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2019-10-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GADNO127251223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics