Provider Demographics
NPI:1639464332
Name:PACKARD, KEVIN EARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:EARL
Last Name:PACKARD
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 1:2513 WINDBLOWN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3957
Mailing Address - Country:US
Mailing Address - Phone:509-392-1093
Mailing Address - Fax:
Practice Address - Street 1:4822 HOLLY RD
Practice Address - Street 2:SUITE C
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4734
Practice Address - Country:US
Practice Address - Phone:361-994-4900
Practice Address - Fax:361-994-4989
Is Sole Proprietor?:No
Enumeration Date:2011-06-10
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX270161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice