Provider Demographics
NPI:1013042050
Name:CRESCI, KEVIN EDMOND (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:EDMOND
Last Name:CRESCI
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 1:644 OLD STATE ROUTE 22
Mailing Address - Street 2:
Mailing Address - City:DOVER PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:12522-5822
Mailing Address - Country:US
Mailing Address - Phone:845-832-6325
Mailing Address - Fax:
Practice Address - Street 1:3211 ROUTE 22 STE 1
Practice Address - Street 2:
Practice Address - City:DOVER PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12522-5935
Practice Address - Country:US
Practice Address - Phone:845-877-9294
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0358741122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist