Provider Demographics
NPI:1548616592
Name:GRILL, KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:GRILL
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 1:1241 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:OH
Mailing Address - Zip Code:43302-4446
Mailing Address - Country:US
Mailing Address - Phone:740-387-4804
Mailing Address - Fax:
Practice Address - Street 1:1241 E CENTER ST
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-4446
Practice Address - Country:US
Practice Address - Phone:740-387-4804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-09
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.24716122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist