Provider Demographics
NPI:1114939279
Name:KEVIN MICHAEL SHOWVAKER DMD PC
Entity Type:Organization
Organization Name:KEVIN MICHAEL SHOWVAKER DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHOWVAKER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-847-7692
Mailing Address - Street 1:PO BOX 18
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:PA
Mailing Address - Zip Code:15066
Mailing Address - Country:US
Mailing Address - Phone:724-847-7692
Mailing Address - Fax:724-847-8766
Practice Address - Street 1:416 CONSTITUTION BLVD
Practice Address - Street 2:SUITE D
Practice Address - City:NEW BRIGHTON
Practice Address - State:PA
Practice Address - Zip Code:15066
Practice Address - Country:US
Practice Address - Phone:724-847-7692
Practice Address - Fax:724-847-8766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025430L1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty