Provider Demographics
NPI:1376556597
Name:DORSEY, KEVIN BRENT (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:BRENT
Last Name:DORSEY
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 1:3512 E. FLORENCE AVE.
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90255
Mailing Address - Country:US
Mailing Address - Phone:310-378-6249
Mailing Address - Fax:
Practice Address - Street 1:3512 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5900
Practice Address - Country:US
Practice Address - Phone:323-589-6765
Practice Address - Fax:323-589-4154
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379761223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery