Provider Demographics
NPI:1437279270
Name:MALISON, KEVIN G (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:G
Last Name:MALISON
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 1:123 W WATER ST
Mailing Address - Street 2:
Mailing Address - City:HODGENVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42748-1535
Mailing Address - Country:US
Mailing Address - Phone:270-358-3604
Mailing Address - Fax:270-358-3604
Practice Address - Street 1:123 W WATER ST
Practice Address - Street 2:
Practice Address - City:HODGENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42748-1535
Practice Address - Country:US
Practice Address - Phone:270-358-3604
Practice Address - Fax:270-358-3604
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4676122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist