Provider Demographics
NPI:1225241326
Name:PICKETT, KEVIN L (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:L
Last Name:PICKETT
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6611 WALL ST
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-4555
Mailing Address - Country:US
Mailing Address - Phone:251-607-0110
Mailing Address - Fax:251-607-0112
Practice Address - Street 1:6611 WALL ST
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-4555
Practice Address - Country:US
Practice Address - Phone:251-607-0110
Practice Address - Fax:251-607-0112
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL48731223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics