Provider Demographics
NPI:1639331242
Name:DELHI POINT FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DELHI POINT FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:ELDON
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-583-2789
Mailing Address - Street 1:1303 DELHI
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001
Mailing Address - Country:US
Mailing Address - Phone:563-583-2789
Mailing Address - Fax:562-582-7735
Practice Address - Street 1:1303 DELHI
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001
Practice Address - Country:US
Practice Address - Phone:563-583-2789
Practice Address - Fax:562-582-7735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0003111Medicaid