Provider Demographics
NPI:1467023622
Name:GOLDEN, KEVIN LAMAR (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LAMAR
Last Name:GOLDEN
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 1:2617 ENSEMBLE CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28262-2043
Mailing Address - Country:US
Mailing Address - Phone:770-689-8150
Mailing Address - Fax:
Practice Address - Street 1:8956 J M KEYNES DR STE 500
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28262-8626
Practice Address - Country:US
Practice Address - Phone:980-890-7590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-08
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC99281223G0001X
NC131301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice