Provider Demographics
NPI:1508803735
Name:SCHAMBEAU, KEVIN MCGOWIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MCGOWIN
Last Name:SCHAMBEAU
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 1:6260 PARK SOUTH DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BESSEMER
Mailing Address - State:AL
Mailing Address - Zip Code:35022-5655
Mailing Address - Country:US
Mailing Address - Phone:205-428-2205
Mailing Address - Fax:205-428-9287
Practice Address - Street 1:6260 PARK SOUTH DR
Practice Address - Street 2:SUITE 101
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-5655
Practice Address - Country:US
Practice Address - Phone:205-428-2205
Practice Address - Fax:205-428-9287
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL47371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice