Provider Demographics
NPI:1508070764
Name:DELATOUR, KEVIN B (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:B
Last Name:DELATOUR
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:PO BOX 87
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62812
Mailing Address - Country:US
Mailing Address - Phone:618-435-6772
Mailing Address - Fax:618-438-3333
Practice Address - Street 1:808 NORTH MAIN
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:IL
Practice Address - Zip Code:62812
Practice Address - Country:US
Practice Address - Phone:618-435-6772
Practice Address - Fax:618-438-3333
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist