Provider Demographics
NPI:1467917427
Name:KEVIN T. AXX DDS, PLLC
Entity Type:Organization
Organization Name:KEVIN T. AXX DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:T
Authorized Official - Last Name:AXX
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:602-892-9000
Mailing Address - Street 1:5050 N 40TH ST STE 160
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-9181
Mailing Address - Country:US
Mailing Address - Phone:602-892-9000
Mailing Address - Fax:602-892-8000
Practice Address - Street 1:5050 N 40TH ST STE 160
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-9181
Practice Address - Country:US
Practice Address - Phone:602-892-9000
Practice Address - Fax:602-892-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-04
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty