Provider Demographics
NPI:1578780474
Name:SHUGARS, KEVIN ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ALLEN
Last Name:SHUGARS
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 1:1040 N 10TH ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49009-6149
Mailing Address - Country:US
Mailing Address - Phone:269-372-6333
Mailing Address - Fax:269-372-6732
Practice Address - Street 1:1040 N 10TH ST
Practice Address - Street 2:SUITE 230
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-6149
Practice Address - Country:US
Practice Address - Phone:269-372-6333
Practice Address - Fax:269-372-6732
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI14917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist