Provider Demographics
NPI:1639657869
Name:DOWNEY, KEVIN MATTHEW (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:MATTHEW
Last Name:DOWNEY
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 1:5810 STERLING DR
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-4431
Mailing Address - Country:US
Mailing Address - Phone:192-221-1676
Mailing Address - Fax:
Practice Address - Street 1:17901 TURNERS DR
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1529
Practice Address - Country:US
Practice Address - Phone:574-272-0466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012988A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice