Provider Demographics
NPI:1487661187
Name:MEANY, KEVIN JAMES I (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JAMES
Last Name:MEANY
Suffix:I
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 1:25125 DETROIT RD
Mailing Address - Street 2:BLDG 100
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2547
Mailing Address - Country:US
Mailing Address - Phone:440-835-1060
Mailing Address - Fax:
Practice Address - Street 1:25125 DETROIT RD
Practice Address - Street 2:BLDG 100
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2547
Practice Address - Country:US
Practice Address - Phone:440-835-1060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice