Provider Demographics
NPI:1447780192
Name:LYMPUS, KEVIN O (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:O
Last Name:LYMPUS
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 1:201 S 18TH ST APT 2301
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-5947
Mailing Address - Country:US
Mailing Address - Phone:406-529-6109
Mailing Address - Fax:
Practice Address - Street 1:207 SILVER ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-1805
Practice Address - Country:US
Practice Address - Phone:413-772-0842
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-15
Last Update Date:2017-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857628122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist