Provider Demographics
NPI:1568458560
Name:SCHELLHAAS, KEVIN JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:JOHN
Last Name:SCHELLHAAS
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 1:343 METAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4330
Mailing Address - Country:US
Mailing Address - Phone:504-887-1272
Mailing Address - Fax:504-835-1591
Practice Address - Street 1:343 METAIRIE RD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4330
Practice Address - Country:US
Practice Address - Phone:504-887-1272
Practice Address - Fax:504-835-1591
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-25
Last Update Date:2020-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice