Provider Demographics
NPI:1609974138
Name:CONSANI, KEVIN ULISSE (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:ULISSE
Last Name:CONSANI
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1828 EL CAMINO REAL
Mailing Address - Street 2:SUITE 505
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3103
Mailing Address - Country:US
Mailing Address - Phone:650-697-3450
Mailing Address - Fax:
Practice Address - Street 1:1828 EL CAMINO REAL
Practice Address - Street 2:SUITE 505
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3103
Practice Address - Country:US
Practice Address - Phone:650-697-3450
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA487971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics