Provider Demographics
NPI:1275972820
Name:MCPHERSON, KEVIN ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ROBERT
Last Name:MCPHERSON
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 1:100 S MERRILL AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-1635
Mailing Address - Country:US
Mailing Address - Phone:406-365-1221
Mailing Address - Fax:406-365-1218
Practice Address - Street 1:100 S MERRILL AVE
Practice Address - Street 2:
Practice Address - City:GLENDIVE
Practice Address - State:MT
Practice Address - Zip Code:59330-1635
Practice Address - Country:US
Practice Address - Phone:406-365-1221
Practice Address - Fax:406-365-1218
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2016-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-60091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice