Provider Demographics
NPI:1568013555
Name:KEVIN M. LACOUR, DDS, PC
Entity Type:Organization
Organization Name:KEVIN M. LACOUR, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LACOUR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-921-6606
Mailing Address - Street 1:5400 LAWRENCEVILLE HWY NW STE D
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-5956
Mailing Address - Country:US
Mailing Address - Phone:770-921-6606
Mailing Address - Fax:770-921-6919
Practice Address - Street 1:5400 LAWRENCEVILLE HWY NW STE D
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-5956
Practice Address - Country:US
Practice Address - Phone:770-921-6606
Practice Address - Fax:770-921-6919
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty