Provider Demographics
NPI:1114272226
Name:GUYMON, KEVIN LYNN (D D S)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LYNN
Last Name:GUYMON
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 3RD AVE N
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59401-1508
Mailing Address - Country:US
Mailing Address - Phone:018-698-7632
Mailing Address - Fax:
Practice Address - Street 1:1301 12TH AVE S STE 100
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4600
Practice Address - Country:US
Practice Address - Phone:801-698-7632
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-16
Last Update Date:2019-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8273266-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist