Provider Demographics
NPI:1558848333
Name:MCEVOY, KELSEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:
Last Name:MCEVOY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:0901 SW PALATINE HILL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97219-7833
Mailing Address - Country:US
Mailing Address - Phone:503-944-9503
Mailing Address - Fax:
Practice Address - Street 1:11805 NW CEDAR FALLS DR STE 101
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-2780
Practice Address - Country:US
Practice Address - Phone:971-205-3820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10851122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist