Provider Demographics
NPI:1568114775
Name:VAN ASCH, KEVIN DAVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:DAVIS
Last Name:VAN ASCH
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 1:14960 BULL HILL RD
Mailing Address - Street 2:
Mailing Address - City:OAKBORO
Mailing Address - State:NC
Mailing Address - Zip Code:28129-9650
Mailing Address - Country:US
Mailing Address - Phone:704-519-5068
Mailing Address - Fax:
Practice Address - Street 1:8410 DATAPOINT DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3220
Practice Address - Country:US
Practice Address - Phone:704-519-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC261QD0000X, 390200000X
TX261QD0000X, 390200000X
NC12752122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program