Provider Demographics
NPI:1073674503
Name:KANE, KEVIN ELDON (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ELDON
Last Name:KANE
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 1:1303 DELHI
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-6310
Mailing Address - Country:US
Mailing Address - Phone:563-583-2789
Mailing Address - Fax:563-582-7735
Practice Address - Street 1:1303 DELHI
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-6310
Practice Address - Country:US
Practice Address - Phone:563-583-2789
Practice Address - Fax:563-582-7735
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0003111Medicaid