Provider Demographics
NPI:1215211685
Name:ALBERT, KEVIN S (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:S
Last Name:ALBERT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4808 N. HIGH STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-1554
Mailing Address - Country:US
Mailing Address - Phone:614-261-7210
Mailing Address - Fax:614-261-7211
Practice Address - Street 1:4808 N. HIGH STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-1554
Practice Address - Country:US
Practice Address - Phone:614-261-7210
Practice Address - Fax:614-261-7211
Is Sole Proprietor?:No
Enumeration Date:2011-10-04
Last Update Date:2019-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0286491223G0001X
IL0190286491223G0001X
OH30.024163122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice