Provider Demographics
NPI:1518976539
Name:HUELSMAN, KEVIN SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:SCOTT
Last Name:HUELSMAN
Suffix:
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 1:5763 RUSHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-8817
Mailing Address - Country:US
Mailing Address - Phone:614-718-9488
Mailing Address - Fax:
Practice Address - Street 1:862 PROPRIETORS ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085
Practice Address - Country:US
Practice Address - Phone:614-885-8785
Practice Address - Fax:614-825-6290
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30019427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist