Provider Demographics
NPI:1497728430
Name:BEHN, KEVIN R (DMD, PC)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:R
Last Name:BEHN
Suffix:
Gender:M
Credentials:DMD, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MARISSA
Mailing Address - State:IL
Mailing Address - Zip Code:62257-1341
Mailing Address - Country:US
Mailing Address - Phone:618-295-3703
Mailing Address - Fax:619-285-2636
Practice Address - Street 1:115 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MARISSA
Practice Address - State:IL
Practice Address - Zip Code:62257-1341
Practice Address - Country:US
Practice Address - Phone:618-295-3703
Practice Address - Fax:619-285-2636
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice