Provider Demographics
NPI:1467065326
Name:CORVACHO, KEVIN MELANIO (DDS)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:MELANIO
Last Name:CORVACHO
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 1:2854 N MAIN ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-5413
Mailing Address - Country:US
Mailing Address - Phone:931-456-1138
Mailing Address - Fax:
Practice Address - Street 1:2854 N MAIN ST STE 102
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-5413
Practice Address - Country:US
Practice Address - Phone:931-456-1138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN113751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice